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