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PEDIATRICS Vol. 113 No. 4 April 2004, pp. 806-810

Risk Factors for Emesis After Therapeutic Use of Activated Charcoal in Acutely Poisoned Children

Kevin C. Osterhoudt, MD, MSCE*,{ddagger},§,||,¶, Dennis Durbin, MD, MSCE{ddagger},||,¶, Elizabeth R. Alpern, MD, MSCE{ddagger},|| and Fred M. Henretig, MD*,{ddagger},§,||

* Section of Medical Toxicology
{ddagger} Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
§ Poison Control Center, Philadelphia, Pennsylvania
|| Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Objectives. Vomiting frequently complicates the administration of activated charcoal. The incidence of such vomiting is not defined precisely in the pediatric population. Little is known about the patient-, poison-, or procedure-specific factors that contribute to emesis of charcoal. This study aimed to estimate the incidence of vomiting subsequent to therapeutic administration of charcoal to poisoned children ≤18 years of age and to examine the relative contributions of several risk factors to the occurrence of vomiting.

Methods. Data were collected on a prospective cohort of 275 consecutive children who were treated with activated charcoal for acute poisoning exposure. The study was set in the emergency department of an urban, tertiary-care children’s hospital. Sorbitol content of the charcoal was alternately assigned. Potential risk factors for vomiting were recorded prospectively, and the occurrence of vomiting within 2 hours of charcoal administration was measured.

Results. A total of 56 (20.4%) of 275 patients vomited. Median time to vomiting was 10 minutes. Previous vomiting (relative risk: 3.41; 95% CI: 1.48–7.85) and nasogastric tube administration (relative risk: 2.40; 95% CI: 1.13–5.09) were found to be the most significant independent risk factors for vomiting. The increased risk among children >12 years of age, compared with younger children, approached significance. Sorbitol content, large charcoal volumes, or fast administration rates did not increase vomiting risk significantly.

Conclusions. One of every 5 children who are given activated charcoal within our pediatric emergency department vomited. Children with previous vomiting or nasogastric tube administration were at highest risk, and these factors should be accounted for in future investigation of antiemetic strategies. Sorbitol content of charcoal was not a significant risk factor for emesis.

Key Words: charcoal • decontamination • vomiting • sorbitol • poisoning

Abbreviations: ED, emergency department • CI, confidence interval • RR, relative risk

Received for publication Mar 31, 2003; Accepted Oct 27, 2003.


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Risk of Vomiting After Use of Activated Charcoal
Journal Watch Emergency Medicine, June 30, 2004; 2004(630): 6 - 6.
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