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