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Background: This study assesses whether oral multiple-dose charcoal therapy (MDC) or whole-bowel irrigation (WBI) enhances the excretion of previously absorbed salicylate., Methods: A controlled, randomized, three-limbed crossover protocol was used in nine humans who ingested aspirin. Salicylate levels were measured in serial serum specimens and 32-hour urine collections and kinetic parameters were calculated., Results: There were no differences among the control (CTL), MDC, or WBI groups for area under the serum concentration vs time curve (CTL, 2320 +/- 501 mg/L.h MDC, 2040 +/- 454 mg/L.h; WBI, 2093 +/- 418 mg/L.h) or for urinary salicylates (CTL, 54.9% +/- 9.4%; MDC, 50.9% +/- 8.0%, WBI, 52.4% +/- 13.7% of ingested dose)., Conclusions: Our data do not support the use of either MDC or WBI to enhance the excretion of previously absorbed salicylate in poisoned patients. In patients with drug overdoses, a clear rectal effluent remains as the endpoint for WBI.

Multiple-dose charcoal therapy has been shown to increase the excretion of some drugs. This study assesses the effects of this intervention on salicylate excretion in the postabsorptive phase. Ten human volunteers participated in this randomized, controlled, crossover, two-limbed protocol. On two occasions each volunteer ingested 2880 mg of aspirin. During the experimental limb, 25 g of activated charcoal was ingested at 4, 6, 8, and 10 hours after drug ingestion. Pharmacokinetic data were derived from serial serum salicylate concentrations, and urinary salicylate excretion was quantified. Treatment effects were 9% and 18%, respectively. Although both are significant, they are clinically modest, making multiple-dose charcoal therapy of questionable value for acute salicylate poisoning. Controlled data demonstrating the clinical efficacy of this therapy are required to validate it as an intervention for this condition.

Whole bowel irrigation, routinely used before colonoscopy, is evaluated as a potential gastrointestinal decontamination procedure for acute drug overdose. Nine adult volunteers, who served as their own controls, each ingested 5.0 g of ampicillin trihydrate on two occasions, one week apart. Whole bowel irrigation with polyethylene glycol electrolyte lavage solution was performed one hour after one ingestion. Serial serum ampicillin levels, electrolytes, osmolalities, body weights, and hematocrits were obtained. The areas under the concentration vs time curves for ampicillin were computed for both groups, and their means were compared. Mean duration of the procedure was 234 minutes and mean volume of infused polyethylene glycol electrolyte lavage solution was 7.7 L. Whole bowel irrigation produced a 67% decrease in ampicillin absorption and there were no significant changes in body weight, hematocrit, serum electrolytes, or osmolality. We conclude that whole bowel irrigation is an effective and safe gastrointestinal decontamination procedure for acute drug ingestion.