When to give activated charcoal

    NextPrevious

    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

     

    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.

    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • renal handling of water

      If you were on a tea & toast diet, how much water would you need to drink before you develop hyponatremia? I haven’t seen anyone work out the numbers before so here are my calculations. AndRead more

    • acute acidemia physiology

      As alluded to in the first post, don’t be fooled by a “normal” potassium in the setting of DKA because osmotic diuresis and H+/K+ exchange means that total body potassium is actually LOW. You all knowRead more

    • renal handling of potassium

      the first symptom of hyperkalemia is death Earlier post covered temporizing measures to counter hyperkalemia — namely, intracellular shift, increasing cardiac myocyte threshold potential. Give furosemide if the patient still urinates and consider dialysis, but then askRead more

    • bicarbonate revisited

      Previous post reviewed the safety of balanced crystalloids in hyper K. But what was up with serum bicarbonate decreasing with saline administration? This post introduces a new way of looking at the anion gap to possiblyRead more

    • hyperkalemia and balanced crystalloids

      Is it safe to give LR or plasmalyte to a hyperkalemic patient (these balanced crystalloids have 4-5 mEq/L K as opposed to 0 mEq/L K in normal saline)? Postponing the discussion of renal handling of potassium toRead more

    • hyperkalemia physiology

      You’ll likely encounter hyperkalemia on your next Resus / Cardiac shift, and you’ll instinctively treat it. But take a moment to review the fascinating physiology behind the “cocktail”! First, consider how K+ is buffered byRead more

    • Slow down your tachycardia (but not really)

      You’re sitting in resus bemoaning the departure of your most beloved attending when suddenly a patient wheels in without warning. The patient looks relatively stable but the triage RN tells you her heart rate wasRead more

    • Otitis externa: use the ear wick!

      Acute otitis externa (AOE) is a common complaint seen in pediatric as well as adult emergency departments. AOE is typically not accompanied by acute otitis media, although concurrent cases are possible. Also called “swimmer’s ear”Read more

    NextPrevious