Activated charcoal is indicated for patients who have ingested certain drugs and toxins because it

See also

Poisoning – Acute Guidelines for initial management
Anticonvulsant poisoning
Tricyclic Antidepressant (TCA) poisoning
Salicylates poisoning

For 24 hour advice, contact the Victorian Poisons Information Centre on 13 11 26  

Key points

1. Activated charcoal has a very limited role in the treatment of childhood poisoning. It should not be used without consultation with a toxicologist 
2. Aspiration of activated charcoal can cause significant morbidity and mortality. Nasogastric tube position must be confirmed on chest X-ray before administering activated charcoal
3. If indicated, activated charcoal should be administered as soon as possible, usually within 1 to 2 hours of the exposure 

Background 

Activated charcoal is very rarely indicated in children.  It should only be used in potentially severe poisonings where supportive care and antidote therapy alone would result in a poor outcome, ie where the benefits outweigh the potential risks

Activated charcoal is a form of carbon that binds to many drugs and toxins, reducing further absorption from the gastrointestinal tract and increasing elimination of some drugs (‘gastrointestinal dialysis’) if multiple doses of charcoal are given 

Investigations:

Specific drug concentrations may be measured, although these results (and other blood tests) would return too late to influence the early consideration of Charcoal 

Acute Management 

1. Resuscitation

Standard procedures and supportive care

 Although charcoal should be administered early after ingestions, it should only be administered after appropriate resuscitation has been administered

 Intubation and ventilation may be required prior to administration.

 2.“Decontamination” 

1.  Activated Charcoal has a very limited role in treatment and should not be used without consultation with a toxicologist. 
2. Consider activated Charcoal  if the patient presents early (for example 1-2 hours) after a potentially severe toxic ingestion (see Table 1)

Table 1: List of selected toxins where activated charcoal may be considered:

Activated Charcoal may need to be considered for other drugs, see individual poisoning guidelines and discuss with toxicologist.

When is Activated Charcoal contraindicated?

Patients with altered/reduced conscious state or at imminent risk of seizures and with unprotected airway 

Table 2: List of toxins where Charcoal is NOT helpful and contraindicated

• Acid,and Alkalis / corrosives
• Cyanide
• Ethanol/methanol/glycols
• Eucalyptus and Essential Oils
• Fluoride
• Hydrocarbons
• Metals - including Lithium, Iron compounds, potassium, lead
• Mineral acids - Boric acid

Adverse Effects: 

• Respiratory - aspiration, progressive respiratory failure; Death.
• Beware oral use with drowsiness, or following the ingestion of substances which could cause rapidly reduced CNS depression or may cause seizures
• Faecal discolouration
• GI obstruction: by bezoar formation 

Administration:

• highly viscous and dilution ratio varies
• minimum of 0.25 parts water:1 part of activated charcoal
• use large bore NG tube eg 10-14 French gauge

Multi dose activated charcoal:

Whilst there is evidence of a pharmacokinetic effect, it is not evident that repeating doses of charcoal improves clinical outcome. Multiple dose activated charcoal should be ceased immediately if bowel sounds disappear

If repeating multiple doses of activated charcoal, consider measuring drug concentrations, as well as monitoring the patients clinical condition

In particular, there is some evidence for repeating Charcoal for life threatening ingestions of carbamazepine, dapsone, phenobarbitone, phenytoin, quinine or theophylline  

When to admit/consult local paediatric team, or who/when to phone

Admission should be considered for all adolescent patients with an intentional overdose 

For 24 hour advice, contact the Victorian Poisons Information Centre on 13 11 26 

When to consider transfer to a tertiary centre

For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.   

Discharge Criteria

See individual poisoning guidelines as appropriate   

Parent information 

Accidental ingestion: Parent information sheet from Victorian Poisons Information centre on the prevention of poisoning 

Intentional self –harm: Referral to local mental health services eg Orygen Youth Health: 1800 888 320  

Recreational poisoning: Referral to YoDAA, Victoria's Youth Drug and Alcohol Advice service: 1800 458 685   

What is the indication for activated charcoal?

How does activated charcoal absorb toxins?

What drugs does activated charcoal interact with?

When is administration of activated charcoal indicated after a poisoning quizlet?