Activated charcoal: Difference between revisions

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==Background==
==General==
*Created from carbonaceous materials
[[File:ActivatedCharcoalPowder BrightField.jpg|thumb|A micrograph of activated charcoal showing fractal-like shape of the particles that provides an enormous surface area. Each particle in this image, despite being only around 0.1 mm across, can have a surface area of several square centimeters.]]
**Pryolysis (heating to 600-900 degrees C in the absence of oxygen
*Type: [[Antidote]]
===Mechanism of action===
*A fine, black, odorless powder recognized for more than 2 centuries as an effective adsorbent of many substances
*Large surface area of the charcoal binds toxins and prevents their absorption
*Common Trade Names: Actidose-Aqua [OTC]; Actidose/Sorbitol [OTC]; Char-Flo with Sorbitol [OTC]; EZ Char [OTC]; Kerr Insta-Char in Sorbitol [OTC]; Kerr Insta-Char [OTC] <ref>Activated Charcoal. online.lexi.com.elibrary.einstein.yu.edu/lco/action/doc/retrieve/docid/patch_f/6579?hl=5864#f_pregnancy-and-lactation. Updated 10/5/15. Accessed 12/30/15. </ref>
 
==Adult Dosing==
*25-100gm PO<ref name="AACT PP" />
*Common standard dose is 50gm
*10:1 ratio of charcoal to xenobiotic typically recommended
*If not pre-mixed best administered in a 1:8 ratio of AC to liquid (water, coke)
*AC alone comparably effective to AC to cathartic (sorbitol, Mg citrate)
**if cathartic is used, it should only be a single time (avoid in [[multidose activated charcoal]] therapy)
**repeated dosages associated with dehydration, hypotension, electrolyte derangements
 
==Pediatric Dosing==
*0.5-1 gm/kg PO<ref name="AACT PP" />
 
==Special Populations==
*[[Drug pregnancy categories‎‎|Pregnancy Rating]]: not absorbed
*[[Pregnancy and lactation drug labeling|Lactation risk]]: not absorbed
*Renal Dosing
**Adult
**Pediatric
*Hepatic Dosing
**Adult
**Pediatric


== Indications ==
==Indications==
*Should be considered for a poisoned or overdosed patient after risk-to-benefit assessment of the ingested substance and patient-specific factors
*Ingested drug is adsorbed by charcoal AND one of the following:  
*Ingested drug is adsorbed by charcoal AND one of the following:  
#Time since ingestion is less than 1-2hr  
**Time since ingestion is less than 1-2hr  
#Drug has significant enterohepatic circulation  
**Drug has significant enterohepatic circulation  
#Drug delays gastric emptying AND time since ingestion is <4hr  
**Drug delays gastric emptying AND time since ingestion is <4hr  
#Drug is a controlled release preparation AND time since ingestion is <12-18hr
**Drug is a controlled release preparation AND time since ingestion is <12-18hr
 
THE KILLER CS
*Cyanide
*Colchicine
*Calcium channel blockers
*Cyclic antidepressants
*Cardioglycosides
*Cyclopeptide mushrooms (''Amanita phalloides'')
*Cocaine
*Cicutoxin (water hemlock)
*Salicylates
 
===AACT recommendations===
===AACT recommendations===
*Does '''''NOT''''' recommend routine charcoal administration to all overdose patients
*Activated charcoal "should not be administered routinely in the management of poisoned patients."<ref name="AACT PP">Chyka PA, Seger D, Krenzelok EP, Vale JA; American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. Position paper: Single-dose activated charcoal. Clin Toxicol (Phila). 2005;43(2):61-87.</ref>
*Consider if patient presents within one hour of an ingestion of a toxic amount of a substance known to be absorbed by charcoal
*Consider if patient presents within one hour of an ingestion of a toxic amount of a substance known to be absorbed by charcoal
**Administration of charcoal after an hour may continue to be beneficial
**Administration of charcoal after an hour may continue to be beneficial
*They emphasize that there is no definitive data that activated charcoal improves clinical outcome
*They emphasize that there is no definitive data that activated charcoal improves clinical outcome


== Contraindications ==
==Contraindications==
*Depressed mental status
*[[Altered mental status]]
*Intestinal obstruction
*Intestinal [[SBO|obstruction]]
*Increased risk of aspiration (eg. Hydrocarbon ingestion)
*Increased risk of aspiration
*Ingestion of substances not absorbed by charcoal
*Ingestion of substances not absorbed by charcoal
*Instances where urgent endoscopy will be needed (eg. Ingestion of caustic material)
*Instances where urgent endoscopy will be needed (eg. Ingestion of caustic material)


== Limitations ==
===Limitations===
*Does not work with:
*Does not work with:
**Heavy metals ([[Iron Toxicity|Iron]], [[Lead Toxicity|Lead]], [[Arsenic]], [[Mercury]], Zinc)
**Heavy metals ([[Iron Toxicity|Iron]], [[Lead Toxicity|Lead]], [[Arsenic]], [[Mercury]], Zinc)
**Inorganic ions ([[Lithium]], Potassium, Sodium, Flouride and Iodine)
**Inorganic ions ([[Lithium]], Potassium, Sodium, Fluoride and Iodine)
**[[Hydrocarbons]]/essential oils
**[[Hydrocarbons]]/essential oils
**Toxic alcohols ([[Ethylene Glycol Toxicity|Ethylene Glycol]], [[Methanol Toxicity|Methanol]], [[Isopropyl Alcohol Toxicity|Isopropanol]])
**Toxic alcohols ([[Ethylene Glycol Toxicity|Ethylene Glycol]], [[Methanol Toxicity|Methanol]], [[Isopropyl Alcohol Toxicity|Isopropanol]])
**Acids/bases
**Acids/bases
**[[Organophosphates]]


== Dose ==
==Adverse Reactions==
#1gm/kg PO
*[[Aspiration Pneumonia and Pneumonitis|Aspiration]]
#Mix with water or juice
*[[Small Bowel Obstruction (SBO)|Bowel obstruction]]


== Administration ==
==Pharmacology==
*PO (at least 50 g of charcoal within 20min)
*Half-life: not absorbed
**It is NOT necessary for charcoal to be administered by a NGT or OGT
*Metabolism: not absorbed
**Improved taste if activated charcoal is chilled
*Excretion: excreted whole in feces
**In children, may mix with juice, yogurt or ice-cream
*Adsorption begins within about 1 minute but may not achieve equilibrium for 10-25 minutes
*Clinical efficacy inversely related to time elapsed after ingestion and depends on rate of adsorption of xenobiotic


== Complications ==
===Mechanism of action===
*[[Aspiration Pneumonia and Pneumonitis|Aspiration]]
*Large surface area of the charcoal binds toxins and prevents their absorption
*[[Small Bowel Obstruction (SBO)|Bowel obstruction]]
*Interrupts enteroenteric/enterohepatic circulation of drugs<ref name="Multi">Position statement and practice guidelines on the use of multi-dose activated charcoal in the treatment of acute poisoning. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol. 1999;37(6):731-51.</ref>
 
==Comments==
*Created by heating wood and other natural materials in an airless environment
*"Activated" by turning into fine powder, which ↑ surface area


== See Also ==
==See Also==
*[[Gastric Lavage]]  
*[[Gastric Lavage]]  
*[[Multidose Activated Charcoal (MDAC)]]
*[[Multidose Activated Charcoal (MDAC)]]


== References ==
==References==
<references/>
<references/>
*Haddad and Winchester's Clinical Management of Poisoning and Overdose
*Uptodate


[[Category:Pharmacology]]
[[Category:Procedures]]  
[[Category:Procedures]]  
[[Category:Tox]]
[[Category:Toxicology]]
[[Category:EMS]]
[[Category:EMS]]

Latest revision as of 17:40, 5 March 2025

General

A micrograph of activated charcoal showing fractal-like shape of the particles that provides an enormous surface area. Each particle in this image, despite being only around 0.1 mm across, can have a surface area of several square centimeters.
  • Type: Antidote
  • A fine, black, odorless powder recognized for more than 2 centuries as an effective adsorbent of many substances
  • Common Trade Names: Actidose-Aqua [OTC]; Actidose/Sorbitol [OTC]; Char-Flo with Sorbitol [OTC]; EZ Char [OTC]; Kerr Insta-Char in Sorbitol [OTC]; Kerr Insta-Char [OTC] [1]

Adult Dosing

  • 25-100gm PO[2]
  • Common standard dose is 50gm
  • 10:1 ratio of charcoal to xenobiotic typically recommended
  • If not pre-mixed best administered in a 1:8 ratio of AC to liquid (water, coke)
  • AC alone comparably effective to AC to cathartic (sorbitol, Mg citrate)
    • if cathartic is used, it should only be a single time (avoid in multidose activated charcoal therapy)
    • repeated dosages associated with dehydration, hypotension, electrolyte derangements

Pediatric Dosing

  • 0.5-1 gm/kg PO[2]

Special Populations

Indications

  • Should be considered for a poisoned or overdosed patient after risk-to-benefit assessment of the ingested substance and patient-specific factors
  • Ingested drug is adsorbed by charcoal AND one of the following:
    • Time since ingestion is less than 1-2hr
    • Drug has significant enterohepatic circulation
    • Drug delays gastric emptying AND time since ingestion is <4hr
    • Drug is a controlled release preparation AND time since ingestion is <12-18hr

THE KILLER CS

  • Cyanide
  • Colchicine
  • Calcium channel blockers
  • Cyclic antidepressants
  • Cardioglycosides
  • Cyclopeptide mushrooms (Amanita phalloides)
  • Cocaine
  • Cicutoxin (water hemlock)
  • Salicylates

AACT recommendations

  • Activated charcoal "should not be administered routinely in the management of poisoned patients."[2]
  • Consider if patient presents within one hour of an ingestion of a toxic amount of a substance known to be absorbed by charcoal
    • Administration of charcoal after an hour may continue to be beneficial
  • They emphasize that there is no definitive data that activated charcoal improves clinical outcome

Contraindications

  • Altered mental status
  • Intestinal obstruction
  • Increased risk of aspiration
  • Ingestion of substances not absorbed by charcoal
  • Instances where urgent endoscopy will be needed (eg. Ingestion of caustic material)

Limitations

Adverse Reactions

Pharmacology

  • Half-life: not absorbed
  • Metabolism: not absorbed
  • Excretion: excreted whole in feces
  • Adsorption begins within about 1 minute but may not achieve equilibrium for 10-25 minutes
  • Clinical efficacy inversely related to time elapsed after ingestion and depends on rate of adsorption of xenobiotic

Mechanism of action

  • Large surface area of the charcoal binds toxins and prevents their absorption
  • Interrupts enteroenteric/enterohepatic circulation of drugs[3]

Comments

  • Created by heating wood and other natural materials in an airless environment
  • "Activated" by turning into fine powder, which ↑ surface area

See Also

References

  1. ↑ Activated Charcoal. online.lexi.com.elibrary.einstein.yu.edu/lco/action/doc/retrieve/docid/patch_f/6579?hl=5864#f_pregnancy-and-lactation. Updated 10/5/15. Accessed 12/30/15.
  2. ↑ 2.0 2.1 2.2 Chyka PA, Seger D, Krenzelok EP, Vale JA; American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. Position paper: Single-dose activated charcoal. Clin Toxicol (Phila). 2005;43(2):61-87.
  3. ↑ Position statement and practice guidelines on the use of multi-dose activated charcoal in the treatment of acute poisoning. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol. 1999;37(6):731-51.
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