Activated charcoal
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