II. Indications

  1. Patient presents within 1 to 2 hours of a potentially toxic ingestion
  2. Most effective against large and organic molecules and those with poor water solububility
  3. Overdose or Toxin Ingestion
    1. Antidepressants
    2. Aspirin
    3. Aminophylline
    4. Barbiturates
    5. Carbamazepine
    6. Digitalis
    7. Dilantin
    8. Dapsone
  4. Consider multidose Activated Charcoal with agents that undergo enterohepatic reabsorption
    1. Carbamazepine
    2. Theophylline
    3. Phenobarbital
    4. Dapsone
    5. Quinine

III. Precautions

  1. Patient must be low risk for aspiration
    1. Intact mental status or
    2. Advanced Airway with Gastric Tube (or similar protected airway)
  2. Many consumer products now contain Activated Charcoal (e.g. toothpaste, cleansers, supplements)
    1. No significant evidence of benefit in these marketed products
    2. Risk of binding and inactivating prescribed medications
    3. May also cause Constipation, skin irritation, Dental Erosions
    4. (2018) Presc Lett 25(12): 70

IV. Advantages

  1. Few side effects
  2. Most effective method for Unknown Ingestion

V. Contraindications

  1. Decreased Level of Consciousness
  2. Increased risk of Gastrointestinal Bleeding or perforation
  3. Substances for which charcoal is ineffective or risk of aspiration
    1. Mnemonic: CHIME
      1. Caustics or corrosives
      2. Hydrocarbons
      3. Iron
      4. Metals (including Lithium) or Methanol
      5. Ethylene Glycol or Ethanol
      6. Tomaszewski (2016) Household Toxins Lecture, ACEP PEM Conference, Orlando, attended 3/8/2016
    2. Contraindicated agents
      1. Pesticides
      2. Hydrocarbons
      3. Alcohols
      4. Acids
      5. Alkalis
      6. Iron
      7. Lithium
      8. Solvents (e.g. household cleansers)

VII. Safety

  1. See precautions above
  2. Multiple charcoal doses are safe with rare complication (in a patient controlling their airway)
    1. Dorrington (2003) Ann Emerg Med 41:370-7 [PubMed]

VIII. Dosing

  1. Dose
    1. Adult: 25 to 100 grams in 300 to 800 ml water
    2. Child (age 1 to 12 years): 0.3-1.0 g/kg (up to 25-50 grams) in 300 ml water
    3. Child (age <1 year): 0.5 to 1 g/kg (up to 10-25 grams)
  2. May repeat dose every 2-4 hours if bowel sounds present
  3. Additional measures
    1. May be used with Sorbitol 1-2 grams/kg
    2. Consider concurrent use of Antiemetic suppository
    3. Consider administering via Nasogastric Tube

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Related Studies

Ontology: Activated Charcoal (C0001275)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D002606
SnomedCT 32519007, 317852006, 391718002, 398628008
English Charcoal medicinal vegetable, Active Carbon, activated charcoal (medication), Charcoal, Activated, Medicinal Carbon, Activated Charcoal [Chemical/Ingredient], ACTIVATED CHARCOAL, active carbon, charcoal activated, activate charcoal, activate carbon, activated carbon, activated charcoal, medicinal charcoal, Activated charcoal - chemical (substance), Activated charcoal - chemical, Activated charcoal (disorder), Activated charcoal, Activated carbon, Active carbon, Adsorbent charcoal, Charcoal activated, Decolorizing carbon, Medicinal charcoal, Decolourising carbon, Activated charcoal (product), Activated charcoal (substance), Activated Charcoal, CHARCOAL,ACTIVATED
French Charbon activé, Charbon actif
Portuguese Carvão Ativado
Spanish Carbón Activado, carbón activado (producto), carbón activado (sustancia), carbón activado, carbón activo, carbón adsorbente, carbón decolorante, carbón medicinal
German Aktivkohle
Czech aktivní uhlí
Italian Carbone attivo, Carbone attivato