Underhill TJ et al, 1990, UK1 | 60 patients who had taken 5 g or more of paracetamol within 4 hours of attendance. | RCT | Plasma concentrations at 0, 60, 90 and 150 minutes post treatment | Activated charcoal group had significantly better fall in paracetamol concentration at 150 min | Small study |
| Gastric lavage (14) v ipecacuana (21) v activated charcoal (20) v nothing (5) | | | | |
Spilller HA et al, 1994, USA2 | 122 patients with paracetamol overdose within the previous 12 hours. | Observational study | Hepatotoxicity (defined as SGOT over 125 units/l) | Significantly less (5% v 20%) in groups receiving activated charcoal | Spectrum is of patients contacting a poisons centre. No power study. |
| Activated charcoal (40) v activated charcoal and N acetylcysteine (57) v activated charcoal and high dose N acetyl cysteine (25) | | | | |
Buckley NA et al, 1999, Australia3 | 981 consecutive paracetamol poisonings. | Observational study | Risk of “high risk” concentration | Significantly less change of toxic level if activated charcoal given (odds ratio 0.36 {0.23–0.58}) | |
| Gastric lavage and charcoal v charcoal alone v nothing | | | | |