Activated Charcoal
Liverpool Hospital Emergency Department
Indications:
Single dose activated Charcoal (SDAC) – as an adsorbing agent for appropriate poisons with appropriate toxidromes (protected airway or airway not at risk) and risk of significant toxicity
Multi dose activated Charcoal (MDAC) – as an enhanced elimination method for drugs with enterohepatic circulation / gastrointestinal dialysis
- Drugs where MDAC can be considered are Carbamazepine / Colchicine / Dapsone / Barbiturates / Quinine / Theophylline / Phenytoin / Warfarin
Formulation:
- Carbosorb 0.2g/ml (50g/250ml)
Dosage and Administration
SDAC
- 50g (1g/kg paediatric up to maximum 50g) orally or via NG/OGT in intubated patients
- In children can be mixed with ice-cream to improve taste
- Give within 2 hours of estimated time of ingestion
- May be given within 4 hours of ingestion for large ingestions / severe poisonings / modified release preparations
- If intubated can be given any time after ingestion
MDAC (seek advice from Toxicologist)
- Repeat charcoal dosing 25g (0.5mg/kg in children) every 2 hours orally / NGT / OGT or
- 50g every 4 hours orally / NGT / OGT or
- 12.5g/hr enteral feeding pump
Side Effects:
- Aspiration with pneumonitis
- Vomiting
- Impaired absorption of other oral antidotes
Pit Falls
- Drug must be in GIT
- Benefit must outweigh risk of aspiration to patient or complication
- If threatened airway must be intubated
- The following drugs will not bind charcoal – Alcohols / Metals / Hydrocarbons / Acids / Alkali
- Avoid MDAC if there are no bowel sounds / ileus