Toxic Ingestions and Activated Charcoal
HOWARD C. MOFENSON MD1
1 Long Island Regional Poison Control Center, Nassau County Medical Center, Nassau County Medical Center, East Meadow, New York
I would like to bring an error to your attention and suggest an addition to the commentary, "Value of Activated Charcoal in Toxic Ingestions," by E. Elliot (PIR 1984;6:76).
The error concerns the dose of phenobarbital that Berg et al (N Engl J Med 1982;307:642) used. The correct dose is 200 mg/70 kg.
The suggestion for addition is that the usual pediatric dose of activated charcoal is 1 to 2 g/kg of body weight. Eight to ten times the amount of ingested toxin is not applicable: if a child ingested twenty 0.250-mg tablets of digoxin to equal a total toxic dose of 5.0 mg, then the total dose of activated charcoal at ten times this toxic dose would only be 50 mg. I suggest that this method of determining the amount of activated charcoal to be administered not be used. It belongs to the era of the "universal antidote."
Dr Elliott answers: Dr Mofenson did indeed note an error. The volunteers in the study of Berg et al were given 200 mg of phenobarbital per 70 kg of body weight.
Mofenson suggests that the pediatric dose of activated charcoal routinely be based on the child's weight rather than the amount of ingested toxin. Similarly, the tenth edition of The Harriet Lane Handbook (Chicago, Year Book Medical Publishers, Inc, 1984, p 131) recommends a pediatric dose of 0.5 to 1.0 g/kg per dose and an adult maximum of 50 g per dose. It is often clinically impractical to use a charcoal dose of eight to ten times the ingested amount of toxin. Mofenson's point is well taken, and his suggestion should be adopted.
