II. Indications
- Patient presents within 1 to 2 hours of a potentially toxic ingestion
- Most effective against large and organic molecules and those with poor water solububility
- 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 with Gastric Tube (or similar protected airway)
- 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)
- May repeat dose every 2-4 hours if bowel sounds present
- 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
Images: Related links to external sites (from Bing)
Related Studies
| 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 |
