Activated charcoal
Background
- Created by heating wood and other natural materials in an airless environment
- "Activated" by turning into fine powder, which ↑ surface area
Mechanism of action
- Large surface area of the charcoal binds toxins and prevents their absorption
- Interrupts enteroenteric/enterohepatic circulation of drugs[1]
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
- 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)
Dose
Adult
- 25-100gm PO[2]
- Common standard dose is 50gm
Peds
- 0.5-1 gm/kg PO[2]
Limitations
- Does not work with:
- Heavy metals (Iron, Lead, Arsenic, Mercury, Zinc)
- Inorganic ions (Lithium, Potassium, Sodium, Flouride and Iodine)
- Hydrocarbons/essential oils
- Toxic alcohols (Ethylene Glycol, Methanol, Isopropanol)
- Acids/bases
Complications
See Also
References
- ↑ 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.
- ↑ 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.
- Haddad and Winchester's Clinical Management of Poisoning and Overdose
- Uptodate