Activated charcoal

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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
    • repeated dosages associated with dehydration, hypotension, electrolyte derangements

Pediatric Dosing

  • 0.5-1 gm/kg PO[2]

Special Populations

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

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

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

See Also

References

  1. 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. 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.
  3. 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.