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Kevin,

Great summary, thanks!!

KZS MD 
Denver

-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of Kevin Powell
Sent: Thursday, January 04, 2007 5:33 PM
To: [log in to unmask]
Subject: Re: Charcoal with Sorbitol

1991, eh? I go back to 1990 and was trained to consider one dose. It was in
common but not universal use then.

Sorbitol was added as a cathartic to speed colonic transit time of the
charcoal/poison. At least one brand had it already mixed in with the
charcoal. It may produce diarrhea even with some anticholinergic poisons.

It reduced transit time from 23 hrs to 1 hour, per an Ann Emerg Med Dec 1985
article.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Ab
stractPlus&list_uids=4061985

and less dramatically but still significantly accelerated passage per a 1995
Pediatrics article.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Ab
stractPlus&list_uids=7630676

However, Ann Emerg Med articles in 1988 and 1990 suggested the sorbitol
could reduce total aspirin and acetaminophen absorption:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&c
md=Retrieve&dopt=abstractplus&list_uids=3345017
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&c
md=Retrieve&dopt=abstractplus&list_uids=2188536


The use of sorbitol was not endorsed in the 1997 American Academy of
Clinical Toxicology position statement.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&c
md=Retrieve&dopt=abstractplus&list_uids=9482428

It was frowned upon in the 1999 position statement on multiple dose charcoal

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Ab
stractPlus&list_uids=10584586

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.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Ab
stractPlus&list_uids=15362590

Kevin Powell MD PhD FAAP
Urbana, IL
[log in to unmask]


    -----Original Message-----
    From: Pediatric Emergency Medicine Discussion List
    [mailto:[log in to unmask]]On Behalf Of Doc Holiday
    Sent: Thursday, January 04, 2007 5:12 PM
    To: [log in to unmask]
    Subject: Re: Charcoal with Sorbitol


    Sorry. Never heard of it.
    However, I've only been in EM since 1991, so maybe this pre-dates me...
    Anyway, I thought charcoal is messy enough...
    What is Sorbitol supposed to accomplish anyway?

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