Repeat-dose activated charcoal for overdose

D. Enhanced elimination. Hemodialysis is not indicated for disulfiram overdose, but it may remove ethanol and acetaldehyde and has been reported to be effective in treating the acute disulfiram-ethanol interaction. This is not iikeiy to be necessary in patients receiving adequate fluid and pressor support. There are no data to support the use of repeat-dose activated charcoal for any of the disulfiram syndromes. 

Acute overdoses of rifampin are rarely serious. Supportive care, gastric decontamination with activated charcoal for substantial recent ingestions are all that is usually necessary. Given the extensive enterohepatic circulation of rifampin, repeated doses of activated charcoal may enhance elimination however, the clinical utility of the procedure is questionable. Systemic toxicity associated with the chronic administration of rifampin is an indication to discontinue the drug. 

Only six of 36 children who took overdoses of co-phenotrope had signs of atropine overdose (central nervous system excitement, hypertension, fever, flushed dry skin) (1). Opioid overdose (central nervous system and respiratory depression with miosis) predominated or occurred without any signs of atropine toxicity in 33 cases (92%). Diphenoxylate-induced hjrpoxia was the major problem and was associated with slow or fast respiration, hypotonia or rigidity, cardiac arrest, and in three cases cerebral edema and death. Respiratory depression recurred 13-24 hours after the ingestion in seven cases and was probably due to accumulation of difenoxine, an active metabolite of diphenoxylate. Recommended treatment is an intravenous bolus dose of naloxone, followed by a continuous intravenous infusion, prompt gastric lavage, repeated administration of activated charcoal, and close monitoring for 24 hours. 

Hantson P, Vandenplas O, Mahieu P, Wallemacq P, Hassoun A. Repeated doses of activated charcoal and cholestyramine for digitoxin overdose pharmacokinetic data and urinary elimination. J Toxicol Clin Exp 1991 ll(7-8) 401-5. 

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