Activated Charcoal

Aka: Activated Charcoal

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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. Acetaminophen
    2. Amphetamines
    3. Aspirin (and other Salicylates)
    4. Aminophylline
    5. Barbiturates
    6. Beta Blockers
    7. Calcium Channel Blockers
    8. Carbamazepine
    9. Cocaine
    10. Digitalis or Digoxin
    11. Dilantin
    12. Dapsone
    13. Methylxanthines (including Caffeine)
    14. Opioids
    15. Tricyclic Antidepressants
  4. Consider multidose Activated Charcoal with agents that undergo enterohepatic reabsorption
    1. Carbamazepine
    2. Theophylline
    3. Phenobarbital
    4. Dapsone
    5. Quinine
    6. Salicylates

III. 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)

IV. 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

V. 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. Infant (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. May be dissolved in cola or Chocolate milk
    3. Consider concurrent use of Antiemetic suppository
    4. Consider administering via Nasogastric Tube

VI. Adverse Effects

  1. Intestinal Obstruction
  2. Aspiration Pneumonitis

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. Efficacy

  1. Few adverse effects (if airway protected)
  2. Most effective method for acute, Unknown Ingestion

IX. References

  1. Chyka (2005) Clin Toxicol 43(2): 61-87 [PubMed]
  2. Vega (2024) Am Fam Physician 109(2): 143-53 [PubMed]

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