372 Activated Charcoal for Ghb Intoxication in Children: An in Vitro Study

Background and Aims Treatment of intentional (mainly by adolescents) and unintentional (mainly by children) intoxications with the increasingly popular drug gamma-hydroxybutyrate (GHB) primarily consists of symptomatic treatment. The usually rapid absorption and the need for intubation argue against activated charcoal (AC) treatment in GHB intoxications. However, the use of AC has been suggested in several guidelines and in literature, but it has never been demonstrated to what extent GHB binds (adsorbs) to AC. Reduction of GHB absorption by AC administration could be clinically relevant, especially in children. Therefore, binding of GHB to AC in an in vitro model was tested. Methods Different quantities (2.5, 5, 7.5, or 10 grams) of AC were mixed with a dose of 800 mg GHB at 37°C in 100 mL simulated gastric (pH 1.2) or intestinal (pH 7.2) fluid, respectively. Subsequently, after 15 minutes of incubation the AC was separated from the liquid by centrifugation and the remaining GHB quantified by gas chromatography. GHB binding to AC was plotted in a binding curve. Results Binding of GHB to AC was dose-dependent. At gastric pH, binding was higher than at intestinal pH, with a maximum binding of 84.3% and 23.3%, respectively, with 10 grams of AC, corresponding with a high adult dose. Conclusions AC has GHB binding capacity, which is pH dependent. In case of (un)intentional intake of GHB by children, rapid treatment with AC may be considered.