Wong Cheung Lun William, Chan Chi Keung, Lau Fei Lung
Department of Accident and Emergency, Gleneagles Hospital, Hong Kong SAR, Hong Kong.
Hong Kong Poisoning Information Centre, Hong Kong SAR, Hong Kong.
Clin Toxicol (Phila). 2025 Jun;63(6):420-425. doi: 10.1080/15563650.2025.2499537. Epub 2025 Jun 2.
This study aimed to assess the effectiveness of early activated charcoal administration for the management of single-dose paracetamol overdoses in Hong Kong.
We retrospectively analyzed electronic records from 2010 to 2020 to identify patients with paracetamol overdose. The inclusion criteria comprised individuals over the age of 12 years with a known toxic dose (≥7.5 g) of a standard paracetamol preparation, available serum paracetamol concentration, and a known ingestion time within 4 h. Patients were categorized into either an activated charcoal group or a no activated charcoal group. The paracetamol ratio (serum paracetamol concentration divided by the corresponding concentration on the 150 mg/L at 4 h treatment line) and the need for acetylcysteine were compared. The effect of the timing of activated charcoal administration was also investigated.
Of the 1,274 screened cases, 601 met the inclusion criteria. Activated charcoal was administered to 366 patients at a median time of 89 min (IQR: 56-134 min) post-ingestion, including 140 who received pre-hospital activated charcoal at a median time of 55 min (IQR: 56-134 min). Acetylcysteine was required by 18.3% of the activated charcoal group and 35.3% of the no activated charcoal group. Odds ratios for acetylcysteine requirement decreased with earlier administration: 0.23 at 1 h (95% CI: 0.11-0.45; 0.001), 0.24 at 1-2 h (95% CI: 0.13-0.42; <0.001) and 0.49 at 2-3 h (95% CI: 0.25-0.94; = 0.037).
Pre-hospital administration of activated charcoal is now feasible in Hong Kong. Although activated charcoal is not a life-saving intervention, it appears to reduce the need for antidote treatment. Early activated charcoal administration is associated with reducing acetylcysteine requirements in paracetamol overdoses up to 3 h post-ingestion. Elderly patients showed higher acetylcysteine needs (adjusted OR: 4.31; 95% CI: 1.53-11.96; = 0.005).
Early activated charcoal administration, including pre-hospital use, was significantly associated with a reduced acetylcysteine requirement for paracetamol overdose, with benefits observed up to 3 h post-ingestion.
本研究旨在评估早期给予活性炭对香港地区单次服用过量对乙酰氨基酚的治疗效果。
我们回顾性分析了2010年至2020年的电子记录，以确定对乙酰氨基酚过量的患者。纳入标准包括年龄在12岁以上、已知标准对乙酰氨基酚制剂的中毒剂量（≥7.5克）、可获得的血清对乙酰氨基酚浓度以及已知在4小时内的服药时间。患者被分为活性炭组或非活性炭组。比较对乙酰氨基酚比值（血清对乙酰氨基酚浓度除以4小时治疗线时150毫克/升的相应浓度）和使用乙酰半胱氨酸的必要性。还研究了给予活性炭的时间的影响。
在1274例筛查病例中，601例符合纳入标准。366例患者在摄入后中位时间89分钟（四分位间距：56 - 134分钟）给予活性炭，其中140例在院前中位时间55分钟（四分位间距：56 - 134分钟）接受了活性炭。活性炭组18.3%的患者和非活性炭组35.3%的患者需要使用乙酰半胱氨酸。随着给药时间提前，使用乙酰半胱氨酸的比值比降低：1小时时为0.23（95%置信区间：0.11 - 0.45；P < 0.001），1 - 2小时时为0.24（95%置信区间：0.13 - 0.42；P < 0.001），2 - 3小时时为0.49（95%置信区间：0.25 - 0.94；P = 0.037）。
在香港，院前给予活性炭现在是可行的。虽然活性炭不是一种挽救生命的干预措施，但它似乎减少了解毒治疗的必要性。早期给予活性炭与减少摄入对乙酰氨基酚后长达3小时内对乙酰半胱氨酸的需求有关。老年患者显示出更高的乙酰半胱氨酸需求（调整后的比值比：4.31；95%置信区间：1.53 - 11.96；P = 0.005）。
早期给予活性炭，包括院前使用，与减少对乙酰氨基酚过量时对乙酰半胱氨酸的需求显著相关，在摄入后长达3小时内都观察到了益处。
