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Activated Charcoal
Aka: Activated Charcoal
- Indications
- Patient presents within 60 minutes of a potentially toxic ingestion
- Overdose or Toxin Ingestion
- Antidepressants
- Aspirin
- Aminophylline
- Barbiturates
- Carbamazepine
- Digitalis
- Dilantin
- Dapsone
- 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
- Advantages
- Few side effects
- Most effective method for Unknown Ingestion
- 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 (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)
- Complications
- Intestinal Obstruction
- Aspiration Pneumonitis
- Safety
- See precautions above
- Multiple charcoal doses are safe with rare complication
- Dorrington (2003) Ann Emerg Med 41:370-7 [PubMed]
- 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
- Child (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
- Consider concurrent use of Antiemetic suppository
- Consider administering via Nasogastric Tube
- References
- Chyka (2005) Clin Toxicol 43(2): 61-87 [PubMed]