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From :  Antonio E. Muniz, Md <[log in to unmask]>
>The better topic to debate is whether charcoal itself has any role in 
>overdoses.

--> That is, indeed, a better topic. However, I would be reluctant to assess 
charcoal in "overdoses" - we should be looking at it in terms of each 
different overdose, as THERE IS good data out to show that it works to 
different extents even on the drugs that it does work for...

From :  Kevin Powell <[log in to unmask]>
>1991, eh? I go back to 1990

--> Old man!

>and was trained to consider one dose. It was in common but not universal 
>use then.

--> I was trained in other bits of the universe, then,

>Sorbitol was added as a cathartic to speed colonic transit time

--> Ah!

>It reduced transit time from 23 hrs to 1 hour, per an Ann Emerg Med Dec 
>1985
and less dramatically but still significantly accelerated passage per a 1995 
Pediatrics article.

--> So... the world became more constipated over that decade, eh?

>However, Ann Emerg Med articles in 1988 and 1990 suggested the sorbitol 
>could reduce total aspirin and acetaminophen absorption:
The use of sorbitol was not endorsed in the 1997 American Academy of 
Clinical Toxicology position statement.

--> I take it to mean that, when they appraised the evidence for quality in 
1997, they found that, despite the above articles, there was better evidence 
against it or insufficient useful evidence for it. The absence of 
endorsement even in a field of so few players, means they really couldn't 
support it.

>It was frowned upon in the 1999 position statement on multiple dose 
>charcoal
A review in 2004 found no new evidence that would alter the 1997 position of 
"routine use ... is not endorsed," and if used, limited to a single dose.

--> And this all seems to explain why I have not heard of it - in the UK 
cost is a big issue, so it's even more difficult to get the NHS to pay for 
something unlesss it's proven to be worth it...

From :  Randy King <[log in to unmask]>
>not much evidence
Ann Emerg Med. 1990 Jun;19(6):654-6.
Contribution of sorbitol combined with activated charcoal in prevention of 
salicylate absorption.
... Using a previously described aspirin overdose model, ten healthy 
volunteers...

--> I am beginning to see why this study has been discounted in the current 
recommendations... TEN? A quick calculation will probably show it's too 
small a sample for a pilot, never mind a full study...

>In phase 1 of the study, subjects consumed 2.5g aspirin

--> This is NOT an overdose!

>This study demonstrates that the addition of sorbitol significantly 
>decreases drug absorption in a simulated drug overdose model.

--> Erm, no. It does not. This was NOT an overdose.

>Effects on absorption in actual overdose situations and on patient outcome 
>should be the subjects of further study.

--> And THAT, of course, is where things fall apart for Sorbitol, no? I get 
the feeling this "further study" will not be happening soon...

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