Activated Charcoal for Poisoning Management

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Activated Charcoal in Poisoning Management:

• Activated charcoal is crucial in managing poisoning cases in emergency departments. Its use is indicated within 60 minutes of ingesting certain toxic substances, including antidepressants, aspirin, aminophylline, barbiturates, carbamazepine, digitalis, dilantin, dapsone, and quinine.

Dosage of Activated Charcoal
The recommended dosage of activated charcoal varies depending on age:

• Adults: 25 to 100 grams in 300 to 800 ml of water.
• Children (age 1 to 12 years): 0.3 to 1 g/kg, or 25 to 50 grams, in 300 ml of water.
• Infants: 0.5 to 1 g/kg, or 10-25 grams.

Multidose Activated Charcoal

• In cases of toxic ingestion involving agents that undergo enterohepatic reabsorption, multidose activated charcoal is recommended. These agents include carbamazepine, theophylline, phenobarbital, dapsone, and quinine.
• Multidose activated charcoal, if indicated, may be administered by repeating half the recommended dose every 4 hours.

Complications of Activated Charcoal

• Pulmonary aspiration and a resulting aspiration pneumonitis are the most concerning risks of administration of activated charcoal. In patients with a depressed level of consciousness, providers must consider the risk-to-benefit ratio of intubation for airway protection and the therapeutic benefits of activated charcoal.

Contraindications of Activated Charcoal

• Activated charcoal is contraindicated in patients with decreased level of consciousness, increased risk of gastrointestinal bleeding or perforation, and for substances for which charcoal is ineffective or poses a risk of aspiration. 
• These substances include caustics or corrosives such as acids and alkalis, hydrocarbons, metals such as iron and lithium, alcohols such as ethylene glycol, ethanol, and methanol, and solvents such as household cleansers. 

• Indications of activated charcoal in poisoning caused by pesticides remain controversial due to unknown efficacy and risk of aspiration.