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Activated charcoal and gastric absorption of iron compounds
  1. Steve Jones,
  2. Baha Ali
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
  1. kevin.mackway-jones{at}man.ac.uk

Abstract

A short cut review was carried out to establish whether activated charcoal is effective in iron overdose. Altogether 17 papers were found using the reported search, of which only one was relevant. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this paper are shown in table 4. A clinical bottom line is stated.

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Report by Steve Jones, Specialist Registrar
 Checked by Baha Ali, Senior Clinical Fellow

Clinical scenario

A young woman presents to the emergency department having taken an overdose of her iron tablets. She is in an emotionally distressed state but is cardiovascularly stable and requests treatment. It has been less than two hours since she took the tablets and you prescribe activated charcoal. You wonder whether this will actually do her any good.

Three part question

In [a patient with an iron overdose] is [activated charcoal better than nothing] at [reducing gastric absorption, mortality or morbidity]?

Search strategy

Medline 1966–10/01 using the OVID interface. {(exp poisoning OR poisoning.mp OR exp overdose OR overdose.mp)} AND (exp iron OR exp iron compounds OR iron.mp) AND (exp charcoal OR charcoal.mp OR activated charcoal.mp)} LIMIT to human AND English.

Search outcome

Altogether 17 papers found of which only one was relevant to the original question.

Comment(s)

This study partially answers the question and concludes that more work needs to be done. In the doses given to these healthy patients, activated charcoal reduced absorption; this was reduced further by adding desferrioaxamine to the oral solution. Toxic doses are considered to be fourfold higher than the doses used in the study and treatment in this group of patients depends on clinical features.

CLINICAL BOTTOM LINE

Giving oral activated charcoal may well reduce gastric absorption after iron overdose.

Table 4

Report by Steve Jones, Specialist Registrar
 Checked by Baha Ali, Senior Clinical Fellow

References

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