Gilbert Sophie, St-Onge Maude, Neveu Xavier
Faculté de Médecine, Département de Médecine Familiale et de Médecine d'urgence, Université Laval, Québec, QC, Canada.
Faculté de Médecine, Département d'anesthésie et de soins intensifs, Université Laval, Québec, QC, Canada.
CJEM. 2025 May;27(5):373-380. doi: 10.1007/s43678-025-00881-x. Epub 2025 Mar 25.
Activated charcoal is the primary agent recommended for gastrointestinal decontamination. Current Canadian practices regarding its administration in poisoned patients are not well known. Our objectives were to measure the frequency of administration of activated charcoal in poisoned patient over the age of five, identify the potential determinants of its use, and describe the characteristics as well as the clinical outcomes in intoxicated patients.
In a multicenter health records review, we reviewed poisonings using data collected from health records between January 2015 and January 2016, at different hospitals in Quebec, Canada. We included all poisoned patients over the age of 5 who presented and were managed in the emergency department within 12 h of ingestion of a potentially toxic dose of a carbo-absorbable substance. The primary endpoint was the progression of toxicity, and the secondary endpoints were mortality and length of stay. We calculated the incidence of administration of activated charcoal and identified the observed side effects.
A total of 120 of the 935 poisoned patients received activated charcoal (12.8%). A short post-ingestion time (< 90 min) was the preferred indication for its administration. Charcoal-treated patients had a 9.2% lower risk of increased toxicity in the first 12 h, but twice the likelihood of being admitted to the hospital, and of having a length of stay of 12 h or more. The most common side effect was vomiting (20.8%). Only one of the patients who received it had aspiration pneumonia (0.01%) and two patients subsequently had gastrointestinal obstruction after receiving activated charcoal (0.02%).
Among patients who were poisoned with a carbo-absorbable substance, 12.8% were treated with activated charcoal in the emergency department. The majority of patients progressed well clinically. Our results will contribute to developing a protocol for a pan-Canadian prospective multicenter randomized controlled trial to evaluate the efficacy of activated charcoal in this population.
活性炭是推荐用于胃肠道去污的主要药物。目前加拿大在中毒患者中使用活性炭的做法尚不为人所知。我们的目的是测量五岁以上中毒患者使用活性炭的频率，确定其使用的潜在决定因素，并描述中毒患者的特征及临床结局。
在一项多中心健康记录回顾中，我们使用从2015年1月至2016年1月加拿大魁北克不同医院的健康记录中收集的数据来回顾中毒情况。我们纳入了所有五岁以上、摄入潜在有毒剂量的可被碳吸附物质后12小时内就诊并在急诊科接受治疗的中毒患者。主要终点是毒性进展，次要终点是死亡率和住院时间。我们计算了活性炭的使用发生率并确定了观察到的副作用。
935例中毒患者中有120例接受了活性炭治疗（12.8%）。摄入后短时间（<90分钟）是使用活性炭的首选指征。接受活性炭治疗的患者在最初12小时内毒性增加的风险降低了9.2%，但住院的可能性增加了一倍，住院时间为12小时或更长的可能性也增加了一倍。最常见的副作用是呕吐（20.8%）。接受活性炭治疗的患者中只有1例发生吸入性肺炎（0.01%），2例患者在接受活性炭治疗后随后发生胃肠道梗阻（0.02%）。
在摄入可被碳吸附物质中毒的患者中，12.8%在急诊科接受了活性炭治疗。大多数患者临床进展良好。我们的结果将有助于制定一项全加拿大前瞻性多中心随机对照试验的方案，以评估活性炭在该人群中的疗效。
