When to give activated charcoal


    When to give activated charcoal

    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



    • 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.



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

    Uptodate. Gastrointestinal decontamination of the poisoned patient.

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