Repetitive Doses of Activated Charcoal in Dapsone Poisoning in a Child

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Abstract
A case of Dapsone poisoning, treated by repetitive dosing with activated charcoal, is reported. This 18-month-old child showed remarkably rapid resolution of his symptoms with this mode of therapy, becoming symptom free in 64 h. This rapid improvement is attributed to interruption by activated charcoal of the entero-hepatic circulation of Dapsone. This mode of therapy may be indicated for other compounds having an enterohepatic circulation. Activated charcoal is a generally well-accepted agent for gastrointestinal decontamination in the treatment of oral poisoning in childhood. It is considered a secondary method to induced emesis or gastric lavage for this purpose. Activated charcoal adsorbs a variety of compounds, thereby preventing their systemic adsorption until the charcoal and adsorbed material are excreted by fecal elimination. It is usually recommended that the charcoal be administered in a water slurry as a single dose approximately 10 times that of the ingested toxic material [1]. Several investigators have suggested that repetitive administration of activated charcoal may enhance the clearance of compounds that undergo enterogastric or enterohepatic recirculation or are very slowly adsorbed [2, 3]. Suggestive cases that support this concept have been reported in exposure of adult patients to nortriptyline and Dapsone [3]. To our knowledge there have been no reports of management of such cases in the pediatric literature. Our case illustrates the use of this mode of therapy in a child.