Multidose activated charcoal in acute oleander poisoning - a longitudinal observational study

Abstract

BACK GROUND: Deliberate self-poisoning with yellow oleander seeds is associated with severe cardiac toxicity and a mortality rate of about 5%- 10%. Specialised treatment is expensive and not widely available. Multiple-dose activated charcoal (MDAC) binds cardiac glycosides in the gut lumen and promotes their elimination. There have been conflicting results on whether activated charcoal benefits patients with yellow oleander poisoning. METHODOLOGY: Patients who were admitted to Polonnaruwa General Hospital before September 2007 received single dose charcoal if they presented within two hours of poisoning. Patients who were admitted after September 2007 received MDAC (50 g 6 hourly for 48 hours). In this study, the clinical features and development of serious cardio toxic effects (2nd and 3rd degree heart block) following yellow oleander poisoning was assessed in patients who were admitted during a period of eight months prior to September 2007 and eight months afterwards. RESULTS: There were 254 patients before starting MDAC and 237 patients after starting MDAC. They were of comparable age and sex distribution. Proportion of patients who were transferred with 2nd and 3rd degree heart block for cardiac pacing in the pre MDAC group was 51 (20.1%) 95% CI (15.5%-25.5%). In the post MDAC group it was 30 (12.7%) 95% CI (8.9%-17.3%), the odds ratio was 0.58 (95% CI 0.35-0.94) for this relationship. There was no difference in deaths. Interpretation: The administration of multi dose charcoal in yellow oleander poisoning was associated with a 40% reduction in cardiac toxicity and the need to transfer for pacing.