Activated charcoal reduces the need for N-acetylcysteine treatment after acetaminophen (paracetamol) overdose

Background: The evidence for efficacy of gastric lavage and activated charc oal for gastrointestinal decontamination in poisoning has relied entirely o n volunteer studies and/or pharmacokinetic studies and evidence for any cli nical benefits or resource savings is lacking. Aim of Study: To investigate the value of gastrointestinal decontamination using gastric lavage and/or activated charcoal in acetaminophen (paracetamol) poisoning. Patients and M ethods: We analyzed a series of 981 consecutive acetaminophen poisonings. T hese patients were treated with gastric lavage and activated charcoal, acti vated charcoal alone, or no gastrointestinal decontamination. The decision as to which treatment was received was determined by patient cooperation, t he treating physician, coingested drugs, and time to presentation after the overdose. Results: Of 981 patients admitted over 10 years, 10% (100) had s erum concentrations of acetaminophen that indicated a probable or high risk of hepatotoxicity. The risk of toxic concentrations for patients ingesting less than 10 g of acetaminophen was very low. In patients presenting withi n 24 hours, who had ingested 10 g or more, those who had been given activat ed charcoal were significantly less likely to have probable or high risk co ncentrations (Odds ratio 0.36, 95% CI 0.23-0.58, p < 0.0001). Gastric lavag e, in addition to activated charcoal, did not further decrease the risk (Od ds ratio 1.12, 95% CI 0.57-2.20, p = 0.86). Conclusions: Toxic concentratio ns of serum acetaminophen (paracetamol) are uncommon in patients ingesting less than 10 g. In those ingesting more, activated charcoal appears to redu ce the number of patients who achieve toxic acetaminophen concentrations an d thus may reduce the need for treatment and hospital stay.