Activated charcoal: Difference between revisions

Revision as of 04:34, 17 July 2011

Indications

Drug ingested is adsorbed by charcoal and has significant potential for toxicity, and
One of the following:
1. Time since ingestion is less than 1-2 hours
2. The drug has significant enterohepatic circulation
The drug delays gastric emptying AND time since ingestion is less than 4 hours
The drug is in a controlled release preparation AND time since ingestion is less than 12-18 hours

Dose

1g/kg PO
Mixed with water (sorbitol no longer recommended)

Administration

PO (at least 50 g of charcoal within 20 minutes)
1. It is NOT necessary for charcoal to be administered by a nasogastric or orogastric tube
2. Improved taste if activated charcoal is chilled
3. In children, may mix with juice, yogurt or ice-cream
See also Gastric Lavage

Complications

Aspiration
Bowel obstruction

@@ Line 1: / Line 1: @@
-==Background==
+==Indications==
-if greater than 2 hrs or toxin already in intestine, gastric decontam not helpful
+#Drug ingested is adsorbed by charcoal and has significant potential for toxicity, and
+#One of the following:
+##Time since ingestion is less than 1-2 hours
+##The drug has significant enterohepatic circulation
+#The drug delays gastric emptying AND time since ingestion is less than 4 hours
+#The drug is in a controlled release preparation AND time since ingestion is less than 12-18 hours
--    helpful however if delayed emptying or decreased intest motility
+==Dose==
+#1g/kg PO
+#Mixed with water (sorbitol no longer recommended)
--    always use charcoal asap unless agent/ quantity not toxic, agent not absorbed to charcoal, or delay so long absorption is complete
+==Administration==
+#PO (at least 50 g of charcoal within 20 minutes)
+##It is NOT necessary for charcoal to be administered by a nasogastric or orogastric tube
+##Improved taste if activated charcoal is chilled
+##In children, may mix with juice, yogurt or ice-cream
+#See also [[Gastric Lavage]]
--    gastric emptying before charcoal- higher risk of aspiration, intubation, icu- not routinely recommended
+==Complications==
+# Aspiration
--    gastric emptying helpful if symptomatic within 1 hr, symptomatic with agents that slow gi motility, sustained release meds or massive/ life threatening amount
+#Bowel obstruction
-==Does GI Decont Change Pt Outcome?==
--    effect only if used early- no effect if late
--    however, no prospective trial has proven charcoal or ipecac- only suggests it
--    also, gi decont benefit never disproved either
-==Risks==
-#  aspiration- by cns depression, loss of gag reflex, spont or induced emesis, manipulation of airway or gi tract
-#ipecac assoc with asp if used incorrectly-
-##charcoal usually not assoc with asp- but can be
-##charcoal asp worse than gastric content asp because causes granulomatous reaction, tissue reaction to sorbitol or povidone, increased lung microvascular permeability
-##risk of gastric lavage include unnecessary intubation
-##intubation for airway protection/ aspiration not 100% protective
-#lavage can also damage throat, esoph, stomach
-==Which Pt Not Need GI Decon?==
--    most preschool pts do not need decont
--    no need for decon if nontoxic dose or substance or drug taken so long ago already absorbed.
--    Gi decon reasonable if all pt and all symptomatic pt unless full absorption already occurred- risks of single dose low.
--    However- if low risk pt and uncooperative- may not be worth trauma/ risk to staff or pt
-==Benefit of GI Emptying Before Charcoal?==
--    no- especially not if present late, are asymptomatic.
--    Gastric emptying will not add benefit to charcoal
--    Benefit of charcoal not even proven but is considered state of the art to give unless full absorption already occurred
-==Will Some Pts Benefit From Aggressive GI Decon?==
--    charcoal not useful for iron, lithium alcohol, caustics, hydrocarbons
--    even with sustained release meds, if most of drug has moved beyond stomach, lavage will only hold up charcoal
--    if pt given ipecac and vomits long time before ED presentation- probably don't need additional charcoal for pediatric pts
-ED physician needs to evaluate each ingestions individually and design treatment plan.  If substance poorly aborbed to charcoal- try gastric lavage unless have prolonged delay.  Usually charcoal alone is best choice.  If late presenting pt and asymptomatic- no gi decon needed.  If ealy and symptomatic- personal choice to do gastric lavage followed by charcoal or just charcoal- examine relative risk.
 ==See Also==