/sebin/v/s/HealthLibrary.jpg
bookmark icon Bookmarkprinter iconPrinte-mail icon

Residents Corner

Faculty Corner

Make a Gift

Make a Gift




/sebin/u/t/blankblue.gif

Department of Pediatrics : Academic Divisions : Emergency Medicine : Resident Manual : Pediatric ED Treatment Guidelines : Charcoal Single Dose Administration

Introduction

Medical-grade charcoal is the product of pyrolysis of organic material that is activated by subjecting it to an oxidizing gas at temperatures of 500-900°C. The activating agent removes substances previously adsorbed on charcoal and breaks down granules of carbon into smaller ones having larger surface area. The small particle size and large surface area offers binding sites for adsorption of chemical agents.

Indications

The administration of activated charcoal may be considered if a patient has ingested a potentially toxic amount of a poison up to one hour previously. Besides the ingestion of acetaminophen, there are insufficient data to support or exclude its use after 1 hour of ingestion of other substances. In acetaminophen toxic ingestions administration of charcoal within two hours of ingestion may decrease the need for N-acetylcysteine. There is no evidence that the administration of activated charcoal improves clinical outcome.

Contraindications

  • toxins not adsorbed by charcoal; alcohols, iron, boric acid, caustics, lithium, electrolyte solutions, hydrocarbons and pesticides
  • increased risk of aspiration; ileus, bowel obstruction, hydrocarbons, unprotected airway or potential for unprotected airway as in patients who ingest toxins that cause altered consciousness (alcohols, anticholinergics, anticonvulsants, antihistamines, barbiturates, clonidine, opiates, organophosphate insecticides, phencyclidine hydrochloride (PCP), phenothiazines, salicylates, sedatives/hypnotics, sulfonylureas, tricyclic antidepressants and gamma hydroxybutyrate (GHB) or seizures (amphetamines, antihistamines, caffeine, camphor, cocaine, isoniazid, lead, lidocaine, lindane, nicotine, organophosphates, phenothiazines, phencyclidine, plants (water hemlock), salicylates, strychnine, theophylline, tricyclic antidepressants

Dose

  • 1 gram/kg PO or nasogastric tube
  • If exact amount of drug ingested is known, then 10 grams per 1 gram of ingested drug
  • Maximum dose 50 grams

Note: charcoal can be diluted with chocolate milk (1:1 volume), Coca-Cola (1:1 volume) or cherry syrup (5ml per 30ml charcoal). The adsorptive capacity of charcoal is not significantly effected. However, remember that charcoal is effective if given within 1 hour of ingestion. If PO administration is not immediately successful despite flavoring, nasogastric tube administration is recommended. Confirm NG tube placement by auscultation of air turbulence over stomach. Do not administer charcoal per NG tube in patient with altered consciousness unless patient is intubated with a cuffed tracheal tube and tracheal tube and NG tube location are confirmed by x-ray.

Note: premixed charcoal with cathartic (sorbitol or magnesium citrate) not recommended in children because of the potential for fluid and electrolyte imbalance.

Complications

  • pulmonary aspiration
  • acute lung injury (bronchiolitis obliterans)
  • chronic lung disease
  • laryngitis
  • Note: each of the above pulmonary complications can occur in patients who are intubated.
  • gastrointestinal tract perforation with charcoal peritoneum
  • corneal abrasion

Other Indications

The first dose of multiple-dose activated charcoal treatment is to be administered as soon as possible in the ED. Multiple-dose charcoal regimen is indicated for severe intoxication with salicylates, theophylline, phenobarbital, carbamazepine, or sustained-release preparations. The effectiveness of charcoal treatment and the risk of complications especially for patients with altered mental status or risk for developing altered mental status needs to be considered when initiating multiple-dose charcoal treatment.

References

  • American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. Position Statement: Single-Dose Activated Charcoal. J Toxicology Clinical Toxicology. 1997;35:721-741.
  • Merigian KS, Blaho KE. Single-Dose Activated Charcoal in the Treatment of the Self-Poisoned Patient: A Prospective, Randomized, Controlled Trial. American J Therapeutics. 2002;9:301-308.
  • Osterhoudt KC, Alpern ER, Durbin D, et al. Activated Charcoal Administration in a Pediatric Emergency Department. Pediatric Emergency Care. 2004;20:493-498.
  • Seger D. Single-Dose Activated Charcoal-Backup and Reassess. J Toxicology Clinical Toxicology. 2004;42:101-110.
  • Graff GR, Holcomb GW. Chronic Lung Disease After Activated Charcoal Aspiration. Pediatrics. 2002;109:959-961.
  • Elliott CG, Colby TV, Kelly TM, et al. Charcoal Lung Bronchiolitis Obliterans After Aspiration of Activated Charcoal. Chest. 1989;96:672-674.
  • Givens T, Holloway M, Wason S. Pulmonary Aspiration of Activated Charcoal: A Complication of Its Misuse in Overdose Management. Pediatric Emergency Care. 1992;8:137-140.
  • Donoso A, Linares M, Leon J, et al. Activated Charcoal Laryngitis in an Intubated Patient. Pediatric Emergency Care. 2003;19:420-421.
  • Moll J, Kerns W, Tomaszewski C, et al. Incidence of Aspiration Pneumonia in Intubated Patients Receiving Activated Charcoal. J Emergency Medicine. 1999;17:279-283.
  • McKinney PE, Phillips S, Gomez HF, et al. Corneal Abrasions Secondary to Activated Charcoal. American J Emergency Medicine. 1993;11:562.
  • Skokan EG, Junkins EP, Corneli HM, et al. Taste Test. Children Rate Flavoring Agents Used With Activated Charcoal. Arch Pediatr Adolesc Med. 2001;155:683-686.
  • Dagnone D, Matsui D, Rieder MJ. Assessment of the Palatability of Vehicles for Activated Charcoal in Pediatric Volunteers. Pediatric Emergency Care. 2002;18:19-21.
  • American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicology Clinical Toxicology. 1999;37:731-751.
  • Bradberry SM, Vale JA. Multiple-Dose Activated Charcoal: A Review of Relevant Clinical Studies. J Toxicology Clinical Toxicology. 1995;33:407-416.
  • Buckley NA, Whyte IM, O'Connell DL, et al. Activated Charcoal Reduces the Need for N-acetylcysteine Treatment after Acetaminophen (paracetamol) overdose. J Toxicol Clin Toxicol 1999;37:753-757.


Back | Next