Activated Charcoal Decreases the Risk of QT Prolongation After Citalopram Overdose

Geoffrey Isbister, L FRIBERG, B Stokes, Nicholas Buckley, C Lee, N Gunja, S BROWN, E MacDonald, A Graudlns, A HOLDGATE, S DUFFULL

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Study objective: We determine whether single-dose activated charcoal (SDAC) administration after citalopram overdose reduces the proportion of patients developing abnormal QT prolongation. Methods: Data were collected retrospectively for citalopram overdose patients presenting to 8 emergency departments. Demographics, dose, coingested drugs, SDAC administration, and serial ECGs were extracted from medical records. The primary outcome was the proportion of patients who had an observed QT,RR combination at any time above an abnormal threshold, established as a predictor of torsade de pointes. We compared the proportion of patients with QT prolongation who received or did not receive SDAC. These data were analyzed within a Bayesian framework, using probabilities of abnormal QT,RR combinations with and without derived from a previous single-center study. WinBUGS was used to generate posterior estimates and credible intervals of the relative risk by combining the prior probabilities and the study data. Results: SDAC was administered on average 2.1 hours (range, 0.5 to 6.25 hours) after ingestion in 48 of 254 admissions, and abnormal QT,RR combinations occurred in 2 cases (4.2%), compared with 23 of 206 (11.2%) cases not receiving SDAC. There did not appear to be any clinically important difference in age, sex, dose, and cardiotoxic coingestants between the 2 groups. No cases of torsade de pointes occurred. The estimated relative risk of having an abnormal QT,RR combination for SDAC compared to no SDAC was 0.28 (0.06 to 0.70) (median with 2.5% and 97.5% credible limits). The probability that the relative risk was less than 1.0 was 0.99, which can be interpreted as very strong evidence in favor of a beneficial effect of SDAC. The absolute risk difference was estimated as 7.5% and the median number needed to treat as 13.3. Conclusion: SDAC may be effective in reducing the risk of a prolonged QT in patients after citalopram overdose. Current trends toward nonuse of activated charcoal should be evaluated to determine whether patients poisoned by specific agents may benefit from activated charcoal administration. � 2007 American College of Emergency Physicians.
    Original languageEnglish
    Pages (from-to)593-600
    Number of pages8
    JournalAnnals of Emergency Medicine
    Volume50
    Publication statusPublished - 2007

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    Citalopram
    Charcoal
    Torsades de Pointes
    Numbers Needed To Treat
    Medical Records
    Hospital Emergency Service
    Electrocardiography
    Eating
    Demography

    Cite this

    Isbister, G., FRIBERG, L., Stokes, B., Buckley, N., Lee, C., Gunja, N., ... DUFFULL, S. (2007). Activated Charcoal Decreases the Risk of QT Prolongation After Citalopram Overdose. Annals of Emergency Medicine, 50, 593-600.
    Isbister, Geoffrey ; FRIBERG, L ; Stokes, B ; Buckley, Nicholas ; Lee, C ; Gunja, N ; BROWN, S ; MacDonald, E ; Graudlns, A ; HOLDGATE, A ; DUFFULL, S. / Activated Charcoal Decreases the Risk of QT Prolongation After Citalopram Overdose. In: Annals of Emergency Medicine. 2007 ; Vol. 50. pp. 593-600.
    @article{c20ca772b15e4b85809ee5f2f7509254,
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    abstract = "Study objective: We determine whether single-dose activated charcoal (SDAC) administration after citalopram overdose reduces the proportion of patients developing abnormal QT prolongation. Methods: Data were collected retrospectively for citalopram overdose patients presenting to 8 emergency departments. Demographics, dose, coingested drugs, SDAC administration, and serial ECGs were extracted from medical records. The primary outcome was the proportion of patients who had an observed QT,RR combination at any time above an abnormal threshold, established as a predictor of torsade de pointes. We compared the proportion of patients with QT prolongation who received or did not receive SDAC. These data were analyzed within a Bayesian framework, using probabilities of abnormal QT,RR combinations with and without derived from a previous single-center study. WinBUGS was used to generate posterior estimates and credible intervals of the relative risk by combining the prior probabilities and the study data. Results: SDAC was administered on average 2.1 hours (range, 0.5 to 6.25 hours) after ingestion in 48 of 254 admissions, and abnormal QT,RR combinations occurred in 2 cases (4.2{\%}), compared with 23 of 206 (11.2{\%}) cases not receiving SDAC. There did not appear to be any clinically important difference in age, sex, dose, and cardiotoxic coingestants between the 2 groups. No cases of torsade de pointes occurred. The estimated relative risk of having an abnormal QT,RR combination for SDAC compared to no SDAC was 0.28 (0.06 to 0.70) (median with 2.5{\%} and 97.5{\%} credible limits). The probability that the relative risk was less than 1.0 was 0.99, which can be interpreted as very strong evidence in favor of a beneficial effect of SDAC. The absolute risk difference was estimated as 7.5{\%} and the median number needed to treat as 13.3. Conclusion: SDAC may be effective in reducing the risk of a prolonged QT in patients after citalopram overdose. Current trends toward nonuse of activated charcoal should be evaluated to determine whether patients poisoned by specific agents may benefit from activated charcoal administration. � 2007 American College of Emergency Physicians.",
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    author = "Geoffrey Isbister and L FRIBERG and B Stokes and Nicholas Buckley and C Lee and N Gunja and S BROWN and E MacDonald and A Graudlns and A HOLDGATE and S DUFFULL",
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    Isbister, G, FRIBERG, L, Stokes, B, Buckley, N, Lee, C, Gunja, N, BROWN, S, MacDonald, E, Graudlns, A, HOLDGATE, A & DUFFULL, S 2007, 'Activated Charcoal Decreases the Risk of QT Prolongation After Citalopram Overdose', Annals of Emergency Medicine, vol. 50, pp. 593-600.

    Activated Charcoal Decreases the Risk of QT Prolongation After Citalopram Overdose. / Isbister, Geoffrey; FRIBERG, L; Stokes, B; Buckley, Nicholas; Lee, C; Gunja, N; BROWN, S; MacDonald, E; Graudlns, A; HOLDGATE, A; DUFFULL, S.

    In: Annals of Emergency Medicine, Vol. 50, 2007, p. 593-600.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Activated Charcoal Decreases the Risk of QT Prolongation After Citalopram Overdose

    AU - Isbister, Geoffrey

    AU - FRIBERG, L

    AU - Stokes, B

    AU - Buckley, Nicholas

    AU - Lee, C

    AU - Gunja, N

    AU - BROWN, S

    AU - MacDonald, E

    AU - Graudlns, A

    AU - HOLDGATE, A

    AU - DUFFULL, S

    PY - 2007

    Y1 - 2007

    N2 - Study objective: We determine whether single-dose activated charcoal (SDAC) administration after citalopram overdose reduces the proportion of patients developing abnormal QT prolongation. Methods: Data were collected retrospectively for citalopram overdose patients presenting to 8 emergency departments. Demographics, dose, coingested drugs, SDAC administration, and serial ECGs were extracted from medical records. The primary outcome was the proportion of patients who had an observed QT,RR combination at any time above an abnormal threshold, established as a predictor of torsade de pointes. We compared the proportion of patients with QT prolongation who received or did not receive SDAC. These data were analyzed within a Bayesian framework, using probabilities of abnormal QT,RR combinations with and without derived from a previous single-center study. WinBUGS was used to generate posterior estimates and credible intervals of the relative risk by combining the prior probabilities and the study data. Results: SDAC was administered on average 2.1 hours (range, 0.5 to 6.25 hours) after ingestion in 48 of 254 admissions, and abnormal QT,RR combinations occurred in 2 cases (4.2%), compared with 23 of 206 (11.2%) cases not receiving SDAC. There did not appear to be any clinically important difference in age, sex, dose, and cardiotoxic coingestants between the 2 groups. No cases of torsade de pointes occurred. The estimated relative risk of having an abnormal QT,RR combination for SDAC compared to no SDAC was 0.28 (0.06 to 0.70) (median with 2.5% and 97.5% credible limits). The probability that the relative risk was less than 1.0 was 0.99, which can be interpreted as very strong evidence in favor of a beneficial effect of SDAC. The absolute risk difference was estimated as 7.5% and the median number needed to treat as 13.3. Conclusion: SDAC may be effective in reducing the risk of a prolonged QT in patients after citalopram overdose. Current trends toward nonuse of activated charcoal should be evaluated to determine whether patients poisoned by specific agents may benefit from activated charcoal administration. � 2007 American College of Emergency Physicians.

    AB - Study objective: We determine whether single-dose activated charcoal (SDAC) administration after citalopram overdose reduces the proportion of patients developing abnormal QT prolongation. Methods: Data were collected retrospectively for citalopram overdose patients presenting to 8 emergency departments. Demographics, dose, coingested drugs, SDAC administration, and serial ECGs were extracted from medical records. The primary outcome was the proportion of patients who had an observed QT,RR combination at any time above an abnormal threshold, established as a predictor of torsade de pointes. We compared the proportion of patients with QT prolongation who received or did not receive SDAC. These data were analyzed within a Bayesian framework, using probabilities of abnormal QT,RR combinations with and without derived from a previous single-center study. WinBUGS was used to generate posterior estimates and credible intervals of the relative risk by combining the prior probabilities and the study data. Results: SDAC was administered on average 2.1 hours (range, 0.5 to 6.25 hours) after ingestion in 48 of 254 admissions, and abnormal QT,RR combinations occurred in 2 cases (4.2%), compared with 23 of 206 (11.2%) cases not receiving SDAC. There did not appear to be any clinically important difference in age, sex, dose, and cardiotoxic coingestants between the 2 groups. No cases of torsade de pointes occurred. The estimated relative risk of having an abnormal QT,RR combination for SDAC compared to no SDAC was 0.28 (0.06 to 0.70) (median with 2.5% and 97.5% credible limits). The probability that the relative risk was less than 1.0 was 0.99, which can be interpreted as very strong evidence in favor of a beneficial effect of SDAC. The absolute risk difference was estimated as 7.5% and the median number needed to treat as 13.3. Conclusion: SDAC may be effective in reducing the risk of a prolonged QT in patients after citalopram overdose. Current trends toward nonuse of activated charcoal should be evaluated to determine whether patients poisoned by specific agents may benefit from activated charcoal administration. � 2007 American College of Emergency Physicians.

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    KW - article

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    KW - female

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    KW - male

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    Isbister G, FRIBERG L, Stokes B, Buckley N, Lee C, Gunja N et al. Activated Charcoal Decreases the Risk of QT Prolongation After Citalopram Overdose. Annals of Emergency Medicine. 2007;50:593-600.