PEDIATRIC INGESTIONS - CHARCOAL ALONE VERSUS IPECAC AND CHARCOAL

Study objectives: To determine the effect of syrup of ipecac (SOI) on time to receive and retention of activated charcoal (AC) and on total ED time. Design: During a two-year period, patients were enrolled in a prospective, randomized, unblinded, controlled trial. Setting: All patients were recruited and studied in a pediatric emergency department. Participants: Seventy children less than 6 years old (mean age, 2.4 +/- 0.2 years) who presented with mild-to-moderate acute oral ingestions. Interventions: Group 1 received SOI before AC. Group 2 received only AC. Measurements and main results: Group 1 patients took significantly longer to receive AC than group 2 from the time of ED arrival (2.6 +/- 0.1 vs 0.9 +/- 0.1 hours, P < .0001). Group 1 children were significantly more likely to vomit AC than were group 2 children (18 of 32 vs six of 38, P < .001). Patients receiving SOI who were subsequently discharged spent significantly more time in the ED than those receiving only AC (4.1 +/- 0.2 vs 3.4 +/- 0.2 hours, P < .05). Conclusions: Ipecac delays the administration of AC, hinders its retention, and prolongs ED time in pediatric ingestion patients. These data support the recommendation that AC alone should be the gastrointestinal decontamination method of choice for the mild-to-moderate pediatric ingestion patient presenting to an ED.