de Silva H A, Fonseka M M D, Pathmeswaran A, Alahakone D G S, Ratnatilake G A, Gunatilake S B, Ranasinha C D, Lalloo D G, Aronson J K, de Silva H J
Faculty of Medicine, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
Lancet. 2003 Jun 7;361(9373):1935-8. doi: 10.1016/s0140-6736(03)13581-7.
Deliberate self-poisoning with yellow oleander seeds is common in Sri Lanka and is associated with severe cardiac toxicity and a mortality rate of about 10%. Specialised treatment with antidigoxin Fab fragments and temporary cardiac pacing is expensive and not widely available. Multiple-dose activated charcoal binds cardiac glycosides in the gut lumen and promotes their elimination. We aimed to assess the efficacy of multiple-dose activated charcoal in the treatment of patients with yellow-oleander poisoning.
On admission, participants received one dose of activated charcoal and were then randomly assigned either 50 g of activated charcoal every 6 h for 3 days or sterile water as placebo. A standard treatment protocol was used in all patients. We monitored cardiac rhythm and did 12-lead electocardiographs as needed. Death was the primary endpoint, and secondary endpoints were life-threatening cardiac arrhythmias, dose of atropine used, need for cardiac pacing, admission to intensive care, and number of days in hospital. Analysis was by intention to treat.
201 patients received multiple-dose activated charcoal and 200 placebo. There were fewer deaths in the treatment group (five [2.5%] vs 16 [8%]; percentage difference 5.5%; 95% CI 0.6-10.3; p=0.025), and we noted difference in favour of the treatment group for all secondary endpoints, apart from number of days in hospital. The drug was safe and well tolerated.
Multiple-dose activated charcoal is effective in reducing deaths and life-threatening cardiac arrhythmias after yellow oleander poisoning and should be considered in all patients. Use of activated charcoal could reduce the cost of treatment.
在斯里兰卡，故意服用黄夹竹桃种子进行自我中毒的情况很常见，且与严重的心脏毒性相关，死亡率约为10%。使用抗地高辛Fab片段和临时心脏起搏的专科治疗费用高昂且无法广泛获得。多剂量活性炭可在肠腔内结合强心苷并促进其清除。我们旨在评估多剂量活性炭治疗黄夹竹桃中毒患者的疗效。
入院时，参与者接受一剂活性炭，然后随机分配，一组每6小时服用50克活性炭，共服用3天，另一组服用无菌水作为安慰剂。所有患者均采用标准治疗方案。我们监测心律，并根据需要进行12导联心电图检查。死亡是主要终点，次要终点包括危及生命的心律失常、阿托品使用剂量、心脏起搏需求、入住重症监护病房情况以及住院天数。分析采用意向性治疗。
201例患者接受了多剂量活性炭治疗，200例接受了安慰剂治疗。治疗组死亡人数较少（5例[2.5%]对16例[8%]；百分比差异5.5%；95%CI 0.6 - 10.3；p = 0.025），除住院天数外，我们注意到治疗组在所有次要终点方面均有优势。该药物安全且耐受性良好。
多剂量活性炭可有效降低黄夹竹桃中毒后的死亡率和危及生命的心律失常发生率，所有患者均应考虑使用。使用活性炭可降低治疗成本。
