not much evidence
Ann Emerg Med. 1990 Jun;19(6):654-6.
Contribution of sorbitol combined with activated charcoal in prevention of
Keller RE, Schwab RA, Krenzelok EP.
Department of Emergency Medicine, Geisinger Medical Center, Danville,
The use of cathartics and activated charcoal in treating toxic ingestions
become a standard treatment modality. Sorbitol has been shown to be the most
rapidly acting cathartic, but its therapeutic significance has been debated.
Using a previously described aspirin overdose model, ten healthy volunteers
participated in a crossover design study that investigated the effect of
activated charcoal alone versus that of activated charcoal and sorbitol in
preventing salicylate absorption. In phase 1 of the study, subjects consumed
g aspirin followed by 25 g activated charcoal one hour later. Urine was
collected for 48 hours and analyzed for quantitative salicylate metabolites.
Phase 2 was identical except that 1.5 g/kg sorbitol was consumed with the
activated charcoal. The mean amount of aspirin absorbed without the use of
sorbitol was 1.26 +/- 0.15 g, whereas the mean absorption was 0.912 +/- 0.18g
with the addition of sorbitol. This is a 28% decrease in absorption of
salicylates attributable to the use of sorbitol. The difference is
at P less than .05 by the paired Student's t test. This study demonstrates
the addition of sorbitol significantly decreases drug absorption in a
drug overdose model. Effects on absorption in actual overdose situations and
patient outcome should be the subjects of further study.
PMID: 2188536 [PubMed - indexed for MEDLINE]
Efficacy of ipecac and activated charcoal/cathartic. Prevention of
salicylate absorption in a simulated overdose. [Arch Intern Med. 1984]
Evaluation of the effects of multiple-dose activated charcoal on the
absorption of orally administered salicylate in a simulated toxic ingestion
model. [Ann Emerg Med. 1988] PMID:3337412
Evaluation of a charcoal-sorbitol mixture as an antidote for oral
overdose. [Clin Toxicol. 1977] PMID:608318
Gastrointestinal transit times of cathartics combined with charcoal.
Emerg Med. 1985] PMID:4061985
Sorbitol catharsis does not enhance efficacy of charcoal in a simulated
acetaminophen overdose. [Ann Emerg Med. 1988] PMID:3345017
Randy King MD, FACEP
Emergency Medicine Residency
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