Activated charcoal: Difference between revisions
(Multiple changes: MOA, Sorbitol, AACT recs, Contraindications) |
|||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Created from carbonaceous materials | |||
**Pryolysis (heating to 600-900 degrees C in the absence of oxygen | |||
===Mechanism of action=== | |||
*Large surface area of the charcoal binds toxins and prevents their absorption | |||
===Sorbitol=== | |||
*Recommended to avoid if possible based on the following: | |||
#Evidence for catharsis is scant | |||
#Sorbitol is emetogenic and increases risk of aspiration | |||
#Can lead to life threatening dehydration in infants | |||
== Indications == | |||
*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 | |||
===AACT recommendations=== | |||
*Does '''''NOT''''' recommend routine charcoal administration to all overdose patients | |||
*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 == | |||
*Depressed mental status | |||
*Intestinal obstruction | |||
*Increased risk of aspiration (eg. Hydrocarbon ingestion) | |||
*Ingestion of substances not absorbed by charcoal | |||
*Instances where urgent endoscopy will be needed (eg. Ingestion of caustic material) | |||
== Limitations == | |||
*Does not work with: | *Does not work with: | ||
**[[Iron Toxicity|Iron]] | **Heavy metals ([[Iron Toxicity|Iron]], [[Lead]], [[Arsenic]], [[Mercury]], Zinc) | ||
**[[Lithium]] | **Inorganic ions ([[Lithium]], Potassium, Sodium, Flouride and Iodine) | ||
** | **Hydrocarbons/essential oils | ||
**Toxic alcohols | **Toxic alcohols | ||
**Acids/bases | |||
== Dose == | == Dose == | ||
| Line 19: | Line 42: | ||
== Administration == | == Administration == | ||
*PO (at least 50 g of charcoal within 20min) | |||
**It is NOT necessary for charcoal to be administered by a NGT or OGT | |||
**Improved taste if activated charcoal is chilled | |||
**In children, may mix with juice, yogurt or ice-cream | |||
*See also [[Gastric Lavage]] | |||
== Complications == | == Complications == | ||
*Aspiration | |||
*[[Small Bowel Obstruction (SBO)|Bowel obstruction]] | |||
== See Also == | == See Also == | ||
Revision as of 02:19, 18 December 2013
Background
- Created from carbonaceous materials
- Pryolysis (heating to 600-900 degrees C in the absence of oxygen
Mechanism of action
- Large surface area of the charcoal binds toxins and prevents their absorption
Sorbitol
- Recommended to avoid if possible based on the following:
- Evidence for catharsis is scant
- Sorbitol is emetogenic and increases risk of aspiration
- Can lead to life threatening dehydration in infants
Indications
- 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
AACT recommendations
- Does NOT recommend routine charcoal administration to all overdose patients
- 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
- Depressed mental status
- Intestinal obstruction
- Increased risk of aspiration (eg. Hydrocarbon ingestion)
- Ingestion of substances not absorbed by charcoal
- Instances where urgent endoscopy will be needed (eg. Ingestion of caustic material)
Limitations
- Does not work with:
Dose
- 1gm/kg PO
- Mix with water or juice
Administration
- PO (at least 50 g of charcoal within 20min)
- It is NOT necessary for charcoal to be administered by a NGT or OGT
- Improved taste if activated charcoal is chilled
- In children, may mix with juice, yogurt or ice-cream
- See also Gastric Lavage
Complications
- Aspiration
- Bowel obstruction