First aid treatments for oral poisoning

What is it about?

Review question We reviewed the evidence on the effects of first aid treatments for poisoning that could be feasibly given by people who are not health professionals. Background Many first aid treatments are recommended for treating people who have ingested poisonous substances. Some treatments, such as activated charcoal (AC), bind to the poison, limiting the body's absorption of it. Others may induce vomiting (such as syrup of ipecac) or dilute or neutralize the poison (such as drinking water, milk or juices). Adjusting the person's body position may also have an effect. Study characteristics In December 2018 we searched for high‐quality studies (randomly dividing participants into different treatment groups) investigating treatments for poisoning that laypeople can perform. We found 24 studies with 7099 participants. All but one study took place in hospitals; the remaining one was in a home setting. Fourteen studies either did not specify the type of poison or studied different kinds. The others investigated overdoses of specific medicines (paracetamol, carbamazepine, antidepressant, benzodiazepine) or poisonous plants (yellow oleander or poisonous berries). Twenty‐one trials studied different treatments with activated charcoal: as a single dose or multiple doses, with or without other first aid treatments (a substance to speed up bowel transit), and with or without hospital treatments. Six studies compared syrup of ipecac, with or without other first aid treatments (single‐dose activated charcoal plus bowel transit enhancing substance) versus no treatment. We found no studies that investigated the neutralization or dilution of the poison or the use of certain body positions. Key results Two studies compared a single dose of activated charcoal to no treatment following poisoning with paracetamol or different kinds of poisoning. We are uncertain about the treatment's side effects, admission to intensive care or worsening of the patient, and there was no information about effects on death, symptom duration, poison uptake or hospitalization. One study compared a single dose of activated charcoal to ipecac in mixed types of poisoning. We are uncertain about the effect of activated charcoal compared to ipecac, on the patient's level of coma or the number of unwanted effects. There was no information about effects on death, symptom duration, poison uptake, hospitalization or intensive care admission. One study compared ipecac to no treatment in children who ate poisonous berries at home. There may be an increase in the number of unwanted effects for ipecac. There was no information about effects on death, poisoning symptoms, symptoms duration, poison uptake, hospitalization or intensive care admission. We also investigated the use of single‐dose or multi‐dose activated charcoal, with or without hospital treatment, compared to each other or no treatment. Furthermore, we investigated the added value of ipecac to single‐dose activated charcoal and the added value of adding bowel transit enhancing substances to AC. Certainty of the evidence All but one study took place in a hospital setting, which means that the results cannot be directly applied to the lay setting. Because studies did not always report the methods they used, we are uncertain about the quality of the research conduct for many. Outcomes important to patients and pre‐specified by us as important outcomes for this review were often absent or incompletely reported. Our certainty about the results of this review is mostly low to very low. Therefore future research is highly likely to change the findings. Conclusion Based on the identified evidence, we cannot draw any conclusions about the effects of any of the investigated first aid treatments in a lay setting.

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