Activated charcoal: Difference between revisions
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Latest revision as of 21:55, 20 March 2026
General
- Type: Antidote
- A fine, black, odorless powder recognized for more than 2 centuries as an effective adsorbent of many substances
- Common Trade Names: Actidose-Aqua [OTC]; Actidose/Sorbitol [OTC]; Char-Flo with Sorbitol [OTC]; EZ Char [OTC]; Kerr Insta-Char in Sorbitol [OTC]; Kerr Insta-Char [OTC] [1]
Adult Dosing
- 25-100gm PO[2]
- Common standard dose is 50gm
- 10:1 ratio of charcoal to xenobiotic typically recommended
- If not pre-mixed best administered in a 1:8 ratio of AC to liquid (water, coke)
- AC alone comparably effective to AC to cathartic (sorbitol, Mg citrate)
- if cathartic is used, it should only be a single time (avoid in multidose activated charcoal therapy)
- repeated dosages associated with dehydration, hypotension, electrolyte derangements
Pediatric Dosing
- 0.5-1 gm/kg PO[2]
Special Populations
- Pregnancy Rating: not absorbed
- Lactation risk: not absorbed
- Renal Dosing
- Adult
- Pediatric
- Hepatic Dosing
- Adult
- Pediatric
Indications
- Should be considered for a poisoned or overdosed patient after risk-to-benefit assessment of the ingested substance and patient-specific factors
- Ingested drug is adsorbed by charcoal AND one of the following:
- Time since ingestion is less than 1-2hr
- Drug has significant enterohepatic circulation
- Drug delays gastric emptying AND time since ingestion is <4hr
- Drug is a controlled release preparation AND time since ingestion is <12-18hr
THE KILLER CS
- Cyanide
- Colchicine
- Calcium channel blockers
- Cyclic antidepressants
- Cardioglycosides
- Cyclopeptide mushrooms (Amanita phalloides)
- Cocaine
- Cicutoxin (water hemlock)
- Salicylates
AACT recommendations
- Activated charcoal "should not be administered routinely in the management of poisoned patients."[2]
- Consider if patient presents within one hour of an ingestion of a toxic amount of a substance known to be absorbed by charcoal
- Administration of charcoal after an hour may continue to be beneficial
- They emphasize that there is no definitive data that activated charcoal improves clinical outcome
Contraindications
- Altered mental status
- Intestinal obstruction
- Increased risk of aspiration
- Ingestion of substances not absorbed by charcoal
- Instances where urgent endoscopy will be needed (eg. Ingestion of caustic material)
Limitations
- Does not work with:
- Heavy metals (Iron, Lead, Arsenic, Mercury, Zinc)
- Inorganic ions (Lithium, Potassium, Sodium, Fluoride and Iodine)
- Hydrocarbons/essential oils
- Toxic alcohols (Ethylene Glycol, Methanol, Isopropanol)
- Acids/bases
- Organophosphates
Adverse Reactions
Pharmacology
- Half-life: not absorbed
- Metabolism: not absorbed
- Excretion: excreted whole in feces
- Adsorption begins within about 1 minute but may not achieve equilibrium for 10-25 minutes
- Clinical efficacy inversely related to time elapsed after ingestion and depends on rate of adsorption of xenobiotic
Mechanism of action
- Large surface area of the charcoal binds toxins and prevents their absorption
- Interrupts enteroenteric/enterohepatic circulation of drugs[3]
Comments
- Created by heating wood and other natural materials in an airless environment
- "Activated" by turning into fine powder, which ↑ surface area
Indications by Condition
The following table is automatically generated from disease/condition pages across WikEM.
See Also
References
- ↑ Activated Charcoal. online.lexi.com.elibrary.einstein.yu.edu/lco/action/doc/retrieve/docid/patch_f/6579?hl=5864#f_pregnancy-and-lactation. Updated 10/5/15. Accessed 12/30/15.
- ↑ 2.0 2.1 2.2 Chyka PA, Seger D, Krenzelok EP, Vale JA; American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. Position paper: Single-dose activated charcoal. Clin Toxicol (Phila). 2005;43(2):61-87.
- ↑ Position statement and practice guidelines on the use of multi-dose activated charcoal in the treatment of acute poisoning. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol. 1999;37(6):731-51.