Activated Charcoal: A Quick Summary of a Summary inspired by Dr. Ahra Cho

With all the Tox VMRs going on, we often turn to activated charcoal as a method of decontamination, but we don’t often talk about how exactly activated charcoal works and why sometimes it doesn’t work. The following is adapted from StatPearls.

Indications

  • Toxic ingestions that occur within 1 hour of treatment
  • Can widen the window up to 4 hours if it is a large ingestion, delayed/extended release ingestion, or the ingestant decreases GI motility
  • Pt needs to be able to protect their airway (gag reflex in place, alert/oriented)
  • Ingestant should be absorbed by charcoal

Mechanism of action

  • Lines the GI mucosa and binds toxins preventing initial absorption or reabsorption via enteroheaptic or entero enteric recirculation.
  • Basically works via equilibrium of unbound charcoal complex to charcoal-toxin complex with greatest efficiency when this ratio is around 10:1.
  • Best absorbs: Non polar, poorly water soluble organic toxins
  • Works well for: acetaminophen, aspirin, barbiturates, tricyclic antidepressants, theophylline, phenytoin, and a majority of inorganic and organic materials
  • Does not work well for: alcohols, metals such as iron and lithium, electrolytes such as magnesium, potassium, or sodium, and acids or alkalis

Administration

  • Oral, OG or NG depending on what is tolerated
  • If known ingestion amount, attempt 10:1 weight based (may be difficult in large ingestion)
  • If unknown, single dose: 50g-100g
  • If unknown, multi dose (for medications that recirculate):
    • Loading dose of 25g-100g
    • Repeat 10g-25g q2-4hours

Adverse effects/Contraindications

  • Primarily aspiration/emesis
  • High perforation risk
  • Obstruction

Now you know.

May 2022
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