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Poison Antidote Safe, Effective at Home

Study: Activated charcoal bests syrup of ipecac

MONDAY, Dec. 3, 2001 (HealthDayNews) -- A new study says activated charcoal, a hospital staple used on kids who have swallowed poison, should also be a standby in the home medicine cabinet.

Activated charcoal (AC) has long been physicians' treatment of choice for children who have ingested a toxin. For years, though, it has been used almost exclusively in emergency rooms and not in homes, mainly out of fear that parents or other caretakers wouldn't be able to administer it properly.

The new study finds this fear to be unfounded. It says that moms, dads and other caretakers were able to administer AC just fine, saving both time and money.

"We thought moms could get kids to drink it, and they did," says Henry Spiller, lead author of the study and director of the Kentucky Regional Poison Center in Louisville, where the study was conducted. "If she understands this is going to help the child, she is going to do it." Some moms even expressed relief that they had an alternative to syrup of ipecac, which causes vomiting.

In 1996, the poison center started advising parents to keep AC at home in case their child was unintentionally poisoned. For the next 18 months, the center advised parents who called in and who fulfilled certain criteria to administer AC to their child at home.

If parents didn't have AC on hand, a nurse telephoned nearby pharmacies to see if they had any in stock. If not, parents were told to take the child to the emergency room.

Of 138 parents who were advised to treat their children at home, 115 were successful; the remaining 23 landed in an emergency room.

Professionals at the poison center conducted follow-up telephone calls for three days after the initial contact. After the study ended, an additional 229 children were successfully treated at home with AC.

Administering activated charcoal is not rocket science.

The compound comes in a dry form that can easily be mixed with soda or juice to make the antidote more palatable. (Activated charcoal has no taste, says Spiller, but its gritty texture can be unpleasant). To mitigate the daunting effect of the jet-black color, Spiller suggests mixing the granules with a dark soda, putting a lid on the cup and adding a straw.

Activated charcoal is basically indigestible vegetable matter with a highly convoluted surface (one tablespoon has the surface area of two football fields). It binds with the toxin and ushers it out of the body before it has time to be absorbed.

If taken early enough, the AC will bind with 100 percent of the stomach contents, whereas ipecac gets rid of only about 25 percent to 30 percent, says Spiller.

"That's one of the values of using this at home. If you go to the emergency room, you won't get there for 45 to 60 minutes, and much of the toxin will have been absorbed. Moms were getting to the kids literally right away," says Spiller, who stresses that he is "not attempting to circumvent the emergency room. The ones we're going to treat at home are not going to be the fatal ones."

Ninety-eight of the children studied had ingested mushrooms, six had swallowed cough/cold preparations, and the rest had taken a variety of substances, including cigarette butts, plants and various prescription medications.

Not all health-care professionals are convinced that AC should be given at home, however.

"We'd still like to see some more data before we adopt this as a universal recommendation," says Dr. Joseph Greensher, the medical director at Winthrop University Hospital in Mineola, N.Y. "There's no question about the effectiveness. The problem in the home is the assurance that the child will take it and that he will take it in a sufficient dose -- and that no untoward effects will happen from its wide use."

Dr. Suzanne Doyon, medical director of the Maryland Poison Center in Baltimore, feels that the study did not have enough test subjects or an adequate mix of patients to properly address the issue.

"I don't think it's going to impact clinical practice to any great extent," she says.

What To Do

For poisoning emergencies, call 1-800-222-1222 from any area code.

Although not all physicians agree that activated charcoal should be used at home, it wouldn't hurt to have it on hand in case of an emergency. Activated charcoal costs $4 to $8 and is available over-the-counter at local pharmacies.

If you don't see it on the shelf, Spiller suggests asking the pharmacist, who may have some behind the counter. Doses vary, but Spiller recommends keeping a 15-milligram bottle at home to administer when an emergency arises.

Activated charcoal is not effective with hydrocarbons (gasolines and oils), caustics (acids and alkalines), alcohols and iron. It should not be used if the airway is in any way blocked. If the poisoning is not accidental, obviously, parents should go to the emergency room.

Do you know your poisons? Things lying in a cupboard or medicine chest may seem innocuous to you, but they may be deadly to someone who doesn't know better. Learn more from the American Association of Poison Control Centers or the Consumer Product Safety Commission.

SOURCES: Interviews with Henry Spiller, M.S., director, Kentucky Regional Poison Center, Louisville; Suzanne Doyon, M.D., medical director, Maryland Poison Center, Baltimore; Joseph Greensher, M.D., professor of pediatrics, and medical director, Winthrop University Hospital, Mineola, N.Y.; December 2001 Pediatrics
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