Activated Charcoal in Drug Overdose: A Review

1. Activated Charcoal in Drug Overdose: A Review Presenters: Cheyenne Caldwell, Katelyn Corcoran, Haley Kirchner​ Mentor: Dr. Dale Wurster, Ph.D. 

2. ACTIVATEDCHARCOAL • Treatment of drug overdose for decades​ • Not very many studies on the reason for administration​ • Administration of activated charcoal to a patient is not pleasant ​ • Propose that a compendium be created Figure1. Activated Charcoal. Adapted from “Charcoal business booms in Ondo,” by R. Bamgbose, 2016, News Agency of Nigeria. Retrieved September, 17, 2018, from http://www.nan.ng/business/charcoal-business-booms-ondo/.

3. WHY? Figure 2. Trauma Room Stare Down. Adapted from “Board Vitals,” by BoardVitals Writing Staff, January 8, 2016, Board Vitals. Retrieved September, 17,2018, from https://www.boardvitals.com/blog/emergency-medicine-exam-sample-questions/

4. GOAL To determine which medications that activated charcoal should/shouldn't be  administered for in the event of an emergency overdose

5. OBJECTIVE Evaluate research studies that demonstrate whether or not the administration of activated charcoal is effective at absorbing different drugs. ​ Create a compendium that list the specific scientific studies that demonstrate the effectiveness of administrating activated charcoal for treatment of drug overdose. 

6. METHODS Figure 3. Behind the lab work. Adapted from “Wikipedia Commons,” by M. Diepi, February 5th 2013, Wikipedia Commons. Retrieved September, 17th, 2018, from https://commons.wikimedia.org/wiki/File:Behind_the_lab_work.jpg

7. METHODS SEARCH TERMS EMBASE • ('activated carbon'/exp OR 'activated carbon') AND ('drug overdose'/exp OR 'drug overdose') AND effectiveness​ • ('single drug dose'/exp OR 'single drug dose') AND ('activated carbon'/exp OR 'activated carbon') AND ('drug overdose'/exp OR 'drug overdose')​ • ('single drug dose'/exp OR 'single drug dose') AND ('activated carbon'/exp OR 'activated carbon') AND ('drug overdose'/exp OR 'drug overdose’) • single AND dose AND charcoal​

8. METHODS SEARCH TERMS PUBMED • Charcoal[Mesh] AND "Drug Overdose"[Mesh]​ • "Pharmacokinetics"[Mesh] AND "Charcoal"[Mesh] AND "Drug Overdose"[Mesh] AND ("2007/12/23"[PDat] : "2017/12/19"[PDat])​ • ("Charcoal"[Mesh]) AND "Drug Overdose"[Mesh] ​ • "Pharmacokinetics"[Mesh] AND "Charcoal"[Mesh] AND "Drug Overdose"[Mesh]

9. METHODS Inclusion​ January 1st, 2008-Present​ Primary sourced studies​ Randomized control studies​ Case controls​ Cohort studies ​ Peer-reviewed journals analyzed for bias and credibility​ Exclusion​ Multi-drug-based studies​ Hemodialysis use of activated charcoal Studies outside of time frame​ Secondary and tertiary sourced resources​ Patient case report studies

10. RESULTS ? Figure 4. Physics Math. Adapted from “Celestial Body Swimwear,” Celestial Body. Retrieved September, 17th, 2018, from https://www.celestialbodyswimwear.com/products/andromeda-high-waist-bottom-equations

11. RESULTS Table 1. Activated Charcoal’s Efficacy on Medication KEY - - - No efficacy + Potential Efficacy +++ Proven Efficacy

12. CONCLUSION Figure 5. Emergency Room Sign. Adapted from ”Medical Secrets,” by fortipress, October 17th, 2017. Retrieved September, 19th, 2018, from http://medicalsecrets.com/blog/weed-related-emergency-room-visits-rise/

13. LIMITATIONS List isn’t complete – only certain key terms were analyzed Limited window – January 1st - Present Hospitals have deferred away from using activated charcoal due to patient side effects Activated Charcoal is often used in combination with other medications for overdose treatment – incredibly difficult to determine which drug had the overdose benefit

14. NEXT STEPS

15. REFERENCES Page, C., Duffull, S., Whyte, I., & Isbister, G. (2009). Promethazine overdose: Clinical effects, predicting delirium and the effect of charcoal. QJM: An International Journal of Medicine,102(2), 123-131. doi:10.1093/qjmed/hcn153 Wang, X., Mondal, S., Wang, J., Tirucherai, G., Zhang, D., Boyd, R. A., & Frost, C. (2014). Effect of Activated Charcoal on Apixaban Pharmacokinetics in Healthy Subjects. American Journal of Cardiovascular Drugs,14(2), 147-154. doi:https://doi.org/10.1007/s40256-013-0055-y

16. REFERENCES Gorp, F. V., Duffull, S., Hackett, L. P., & Isbister, G. K. (2012). Population pharmacokinetics and pharmacodynamics of escitalopram in overdose and the effect of activated charcoal. British Journal of Clinical Pharmacology,73(3), 402-410. doi:10.1111/j.1365-2125.2011.04091.x Cooper, J. M., Duffull, S. B., Saiao, A. S., & Isbister, G. K. (2015). The pharmacokinetics of sertraline in overdose and the effect of activated charcoal. British Journal of Clinical Pharmacology,79(2), 307-315. doi:10.1111/bcp.12500 Duffull, S. B., & Isbister, G. K. (2013). Predicting the requirement for N-acetylcysteine in paracetamol poisoning from reported dose. Clinical Toxicology,51(8), 772-776. doi:10.3109/15563650.2013.830733

17. REFERENCES Gude, A. J., Hoegberg, L. C., Angelo, H. R., & Christensen, H. R. (2009). Dose-Dependent Adsorptive Capacity of Activated Charcoal for Gastrointestinal Decontamination of a Simulated Paracetamol Overdose in Human Volunteers. Basic & Clinical Pharmacology & Toxicology,106(5), 406-410. doi:10.1111/j.1742-7843.2009.00503.x Cumpston, K., Stromberg, P., Wills, B. K., & Rose, S. R. (2016). Activated Charcoal Does Not Reduce Duration of Phenytoin Toxicity in Hospitalized Patients. American Journal of Therapeutics,23(3), 773-777. doi:10.1097/mjt.0000000000000058

18. Activated Charcoal in Drug Overdose: A Review Presenters: Cheyenne Caldwell, Katelyn Corcoran, Haley Kirchner​ Mentor: Dr. Dale Wurster, Ph.D.  Figure1. Activated Charcoal. Adapted from “Charcoal business booms in Ondo,” by R. Bamgbose, 2016, News Agency of Nigeria. Retrieved September, 17, 2018, from http://www.nan.ng/business/charcoal-business-booms-ondo/.