Acupressure for prevention of emesis in patients receiving activated charcoal

Objective: Vomiting after activated charcoal decontamination is problematic. Acupressure (traditional Chinese medicine) is an effective treatment for emesis, but has not been tested in overdose patients. We sought to determine (1) the incidence of emesis after activated charcoal and (2) the ability of acupressure to prevent emesis due to activated charcoal. Methods: Consecutive overdose patients were enrolled in a preliminary, prospective study to determine the incidence of emesis after activated charcoal. Awake patients, > 18 years, received 1 g/kg activated charcoal orally or via nasogastric tube, and then observed for 1 hour. These patients served as controls for part 2 of the study, where acupressure bands were placed on overdose patients at the Nei-Guan P-6 point of both wrists prior to activated charcoal, followed by 1 hour observation. Exclusion criteria included: ipecac decontamination, antiemetic drug ingestion, an antiemetic drug therapy within l hour of activated charcoal, or intubation. Results: Eighty-one patients were included in the control group and 106 patients in the acupressure treatment group. Demographics and ingested substances were similar in both groups. 21/81 (25.9%) in the control group vomited and 15/106 (14.2%) in the acupressure group vomited. Acupressure reduced emesis by 46% (p = 0.043; [chi square]). Within the acupressure group, the median duration of prophylactic acupressure was 5 minutes in those patients without vomiting compared to 4 minutes in those patients with vomiting (NS; Wilcoxon rank sum test). Conclusion: The incidence of emesis after activated charcoal at our institution was 26%. Prophylactic acupressure reduced activated charcoal-induced vomiting by 46%. Investigators suggest 5 minutes of acupressure prior to activated charcoal. Key Words: Activated charcoal; Acupressure; Overdose; Decontamination; Traditional Chinese medicine
INTRODUCTION Activated charcoal (AC) is the mainstay for decontamination following toxic exposures. In 2000, over 130,000 patients with toxic exposures received AC in the United States. [1] Activated charcoal is [...]