A patient presents 30 minutes after intentional ingestion of 25 tabs of alprazolam. He is awake and talking, with normal vitals. This is a perfect situation in which to give activated charcoal, something that seems to be often discussed but infrequently given. Below is a quick overview of activated charcoal administration:

 

Mechanism of action: primarily adsorbs a wide variety of toxins to minimize GI absorption. May also increase elimination of absorbed toxins.

 

Indications: within 1-1.5 hours of ingestion of a suspected toxic ingestion, or slightly longer for extended release formulations.

 

How it’s given: comes premixed (typically with sorbitol or water) as a suspension in a tube or bottle. Have the patient drink it if awake. If intubated, can administer through NG tube once tube placement is confirmed via x-ray. Usually given as a single dose, but occasionally given multiple times in very select cases.

 

Complications: vomiting (increased with sorbitol), diarrhea, aspiration, pneumonitis, ARDS

 

Contraindications:

  • any mental status depression, unless intubated
  • delayed presentation – when no residual toxin is likely to be left in the stomach
  • corrosive ingestions such as acid/alkali – obscures endoscopic view, further complicates perforation if it occurs.
  • hydrocarbons – not well adsorbed, easily aspirated if patient vomits given their volatility
  • alcohols, heavy metals (iron), ions (lithium) – not well adsorbed by activated charcoal

 

If you have any questions about whether activated charcoal is indicated, consult the NYC Poison Control Center at 212-POISONS – which you should consider doing anyways for most overdoses.

 

References:

Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care

Uptodate. Gastrointestinal decontamination of the poisoned patient.