In reply

Abstract

We wish to thank Dr. Tenenbein for his comments regarding our study. In his letter, Dr. Tenenbein argues that our study's conclusion—that clinically significant complications associated with the use of multiple-dose activated charcoal occur infrequently—is in error. The crux of Dr. Tenenbein's argument is that our study was underpowered because of how we defined multiple-dose activated charcoal therapy. We defined multiple-dose activated charcoal therapy as: a patient must have been administered at least 2 separate doses, given no less than 1 hour apart, within a 12-hour period. Although no formal, universally accepted definition for multiple-dose activated charcoal exists, we acknowledge that many toxicologists might agree with Dr. Tenenbein that “true” multiple-dose activated charcoal entails 4 or more doses. We do not agree, however, that our particular definition of multiple-dose activated charcoal invalidates either our study's findings or conclusions. There are several reasons outlined in the fourth paragraph of our discussion that provide the basis for our disagreement.