II. Indications
- Patient presents early after potentially toxic ingestion
- Limited to 1-2 hours after ingestion historically, but limit is not strictly followed (consult poison control)
- Some toxic ingestions are associated with Delayed Gastric Emptying and delayed transit times
- Delayed release formulations and pharmaconezoars may extend the time of gastric absorption
- Most effective against large and organic molecules and those with poor water solububility
- Agents must also be carboabsorbable
- Overdose or Toxin Ingestion
- Consider multidose Activated Charcoal with agents that undergo enterohepatic reabsorption
III. Contraindications
- Decreased Level of Consciousness
- Increased risk of Gastrointestinal Bleeding or perforation
- Substances for which charcoal is ineffective or risk of aspiration
- Mnemonic: CHIME
- Caustics or corrosives
- Hydrocarbons
- Iron
- Metals (including Lithium) or Methanol
- Ethylene Glycol or Ethanol
- Tomaszewski (2016) Household Toxins Lecture, ACEP PEM Conference, Orlando, attended 3/8/2016
- Contraindicated agents
- Pesticides
- Hydrocarbons
- Alcohols
- Acids
- Alkalis
- Iron
- Lithium
- Solvents (e.g. household cleansers)
- Mnemonic: CHIME
IV. Precautions
- Patient must be low risk for aspiration
- Intact mental status or
- Advanced Airway AND Gastric Tube (or similar protected airway)
- Avoid charcoal via a Gastric Tube without a secured airway
- Also indicated in a patients at high risk of Seizure following Toxin Ingestion
- Many consumer products now contain Activated Charcoal (e.g. toothpaste, cleansers, supplements)
- No significant evidence of benefit in these marketed products
- Risk of binding and inactivating prescribed medications
- May also cause Constipation, skin irritation, Dental Erosions
- (2018) Presc Lett 25(12): 70
V. Dosing
- Dose
- Adult: 25 to 100 grams in 300 to 800 ml water
- Child (age 1 to 12 years): 0.3-1.0 g/kg (up to 25-50 grams) in 300 ml water
- Infant (age <1 year): 0.5 to 1 g/kg (up to 10-25 grams)
- Multiple Dose Activated Charcoal (MDAC, "gut Dialysis")
- May repeat dose every 2-4 hours if bowel sounds present (M)
- Consider in cases of drugs circulated through enterohepatic circulation (enhanced biliary secretion)
- Additional Dose Activated Charcoal (ADAC)
- Standard doses may be insufficient to decontaminate large ingestions (consider higher dose)
- Additional measures
- May be used with Sorbitol 1-2 grams/kg
- May be dissolved in cola or Chocolate milk
- Consider concurrent use of Antiemetic suppository
- Consider administering via Nasogastric Tube
VI. Adverse Effects
VII. Safety
- See precautions above
- Multiple charcoal doses are safe with rare complication (in a patient controlling their airway)
VIII. Efficacy
- Few adverse effects (if airway protected)
- Most effective method for acute, Unknown Ingestion
IX. References
- Swaminathan and Gosselin (2026) Decontamination Update, EM:Rap, 8/17/2026
- Chyka (2005) Clin Toxicol 43(2): 61-87 [PubMed]
- Vega (2024) Am Fam Physician 109(2): 143-53 [PubMed]