The Use of Activated Charcoal for Acute Poisonings
Poisoning results from the ingestion of or contact with harmful substances including overdose or incorrect use of any drug or medication. Decontamination measures prevent the absorption of the substance from the gastrointestinal tract to minimize systemic effects. Activated charcoal is the intervention most frequently used in the initial management of patients with acute intoxications. The use of activated charcoal has decreased over time, but there may be a subgroup of patients who would benefit from its use. In this review we describe the epidemiology of intoxications, the composition and pharmacology of activated charcoal, indications and dosing for use of single dose and multiple doses of charcoal, contraindications, complications and a summary for recommended use of this measure based on published studies.
2. Greene S, Harris C, Singer J. Gastrointestinal decontami¬nation of the poisoned patient. Pediatr Emerg Care. Mar 2008;24(3):176-186; quiz 187-179.
3. Bailey B. To Decontaminate or Not to Decontaminate? The Balance Between Potential Risks and Foreseeable Benefits. Clin Pediatr Emerg Med. 2008;9(1):17-23.
4. Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 Annual Report of the American Association of Poison Con¬trol Centers' National Poison Data System (NPDS): 32nd Annual Report. Clin Toxicol (Phila). 2015;53(10):962-1147.
5. Thompson TM, Theobald J, Lu J, Erickson TB. The general approach to the poisoned patient. Dis Mon. Nov 2014;60(11):509- 524.
6. Pruss-Ustun A, Vickers C, Haefliger P, Bertollini R. Knowns and unknowns on burden of disease due to chemicals: a syste¬matic review. Environ Health. Jan 21 2011;10:9.
7. Bergen G, Chen LH, Warner M, Fingerhut LA. Injury in the United States: 2007 Chartbook. Hyattsville, MD:. National Center for Health Statistics. 2008.
8. CDC. Increases in age-group-specific injury mortality – United States, 1999–2004. MMWR. 2007;56:1281–1284.
9. Cooney DO. A "superactive" charcoal for antidotal use in poi¬sonings. Clin Toxicol. 1977;11(4):387-390.
10. Heard K. Gastrointestinal decontamination. Med Clin North Am. Nov 2005;89(6):1067-1078.
11. Seger D. Single-dose activated charcoal-backup and reas¬sess. J Toxicol Clin Toxicol. 2004;42(1):101-110.
12. Gaudreault P. Activated Charcoal Revisited. Clin Ped Emerg Med 2005;6:76-80.
13. Jurgens G, Hoegberg LC, Graudal NA. The effect of activated charcoal on drug exposure in healthy volunteers: a meta-analy¬sis. Clin Pharmacol Ther. May 2009;85(5):501-505.
14. Isbister GK, Kumar VV. Indications for single-dose activated charcoal administration in acute overdose. Curr Opin Crit Care. Aug 2011;17(4):351-357.
15. Chyka PA, Seger D. Position statement: single-dose activa¬ted charcoal. American Academy of Clinical Toxicology; Euro¬pean Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol. 1997;35(7):721-741.
16. Cooper GM, Le Couteur DG, Richardson D, Buckley NA. A ran¬domized clinical trial of activated charcoal for the routine ma¬nagement of oral drug overdose. QJM. Sep 2005;98(9):655-660.
17. Eddleston M, Juszczak E, Buckley NA, et al. Multiple-dose activated charcoal in acute self-poisoning: a randomised con¬trolled trial. Lancet. Feb 16 2008;371(9612):579-587.
18. Olson KR. Activated charcoal for acute poisoning: one toxi¬cologist's journey. J Med Toxicol. Jun 2010;6(2):190-198.
19. Bond GR. The role of activated charcoal and gastric empt¬ying in gastrointestinal decontamination: a state-of-the-art re¬view. Ann Emerg Med. Mar 2002;39(3):273-286.
20. Merigian KS, Blaho KE. Single-dose oral activated charcoal in the treatment of the self-poisoned patient: a prospective, ran¬domized, controlled trial. Am J Ther. Jul-Aug 2002;9(4):301-308.
21. Chiew AL, Fountain JS, Graudins A, Isbister GK, Reith D, Buc¬kley NA. Summary statement: new guidelines for the manage¬ment of paracetamol poisoning in Australia and New Zealand.
Med J Aust. Sep 7 2015;203(5):215-218.
22. Bailey B. Gastrointestinal decontamination triangle. Clin To¬xicol (Phila). 2005;43(1):59-60.
23. Lapus RM. Activated charcoal for pediatric poisonings: the universal antidote? Curr Opin Pediatr. Apr 2007;19(2):216-222.
24. Heard K. The changing indications of gastrointestinal decon¬tamination in poisonings. Clin Lab Med. Mar 2006;26(1):1-12, vii.
25. de Silva HA, Fonseka MM, Pathmeswaran A, et al. Multi¬ple-dose activated charcoal for treatment of yellow oleander poisoning: a single-blind, randomised, placebo-controlled trial. Lancet. Jun 7 2003;361(9373):1935-1938.
26. Mahutte CK, True RJ, Michiels TM, Berman JM, Light RW. In¬creased serum theophylline clearance with orally administered activated charcoal. Am Rev Respir Dis. Nov 1983;128(5):820-822.
27. Pond S, Jacobs M, Marks J, Garner J, Goldschlager N, Hansen D. Treatment of digitoxin overdose with oral activated charcoal. Lancet. Nov 21 1981;2(8256):1177-1178.
28. Pond SM, Olson KR, Osterloh JD, Tong TG. Randomized study of the treatment of phenobarbital overdose with repeated do¬ses of activated charcoal. JAMA. Jun 15 1984;251(23):3104-3108.
29. Neuvonen PJ, Elonen E, Mattila MJ. Oral activated char¬coal and dapsone elimination. Clin Pharmacol Ther. Jun 1980;27(6):823-827.
30. Berg MJ, Berlinger WG, Goldberg MJ, Spector R, Johnson GF. Acceleration of the body clearance of phenobarbital by oral activated charcoal. N Engl J Med. Sep 9 1982;307(11):642-644.
31. du Souich P, Caille G, Larochelle P. Enhancement of nadolol elimination by activated charcoal and antibiotics. Clin Pharma¬col Ther. May 1983;33(5):585-590.
32. Berlinger WG, Spector R, Goldberg MJ, Johnson GF, Quee CK, Berg MJ. Enhancement of theophylline clearance by oral acti¬vated charcoal. Clin Pharmacol Ther. Mar 1983;33(3):351-354.
33. Hillman RJ, Prescott LF. Treatment of salicylate poisoning with repeated oral charcoal. Br Med J (Clin Res Ed). Nov 23 1985;291(6507):1472.
34. Honcharik N, Anthone S. Activated charcoal in acute cyclos¬porin overdose. Lancet. May 4 1985;1(8436):1051.
35. Karkkainen S, Neuvonen PJ. Effect of oral charcoal and urine pH on dextropropoxyphene pharmacokinetics. Int J Clin Phar¬macol Ther Toxicol. Apr 1985;23(4):219-225.
36. Neuvonen PJ, Elonen E. Effect of activated charcoal on absorption and elimination of phenobarbitone, carbamaze¬pine and phenylbutazone in man. Eur J Clin Pharmacol. Jan 1980;17(1):51-57.
37. Chan BS, Sellors K, Chiew AL, Buckley NA. Use of multi-dose activated charcoal in phenytoin toxicity secondary to genetic polymorphism. Clin Toxicol (Phila). Feb 2015;53(2):131-133.
38. Toxicology; AAoC, Toxicologists EAoPCaC. Position statement and practice guidelines on the use of multi-dose activated charcoal in the treatment of acute poisoning. J Toxicol Clin To¬xicol. 1999;37(6):731-751.
39. Tenenbein M. Multiple doses of activated charcoal: time for reappraisal II. Ann Emerg Med. Oct 2003;42(4):597-598; author reply 598-599.
40. Levy G. Gastrointestinal clearance of drugs with activated charcoal. N Engl J Med. Sep 9 1982;307(11):676-678.
41. Chyka PA. Multiple-dose activated charcoal and enhance¬ment of systemic drug clearance: summary of studies in animals and human volunteers. J Toxicol Clin Toxicol. 1995;33(5):399-405.
42. Mokhlesi B, Leiken JB, Murray P, Corbridge TC. Adult toxico¬
logy in critical care: part I: general approach to the intoxicated patient. Chest. Feb 2003;123(2):577-592.
43. Ocal O, Ozucelik DN, Avci A, et al. A comparison of the out¬come of CPR according to AHA 2005 ACLS and AHA 2010 ACLS guidelines in cardiac arrest: multicenter study. Int J Clin Exp Med. 2015;8(11):21549-21556.
44. Shin JJ, Randolph GW, Rauch SD. Evidence-based medicine in otolaryngology, part 1: the multiple faces of evidence-based medicine. Otolaryngol Head Neck Surg. May 2010;142(5):637- 646.
45. Daly FF, Little M, Murray L. A risk assessment based approach to the management of acute poisoning. Emerg Med J. May 2006;23(5):396-399.
46. Isbister GK, Downes F, Sibbritt D, Dawson AH, Whyte IM. Aspiration pneumonitis in an overdose population: frequency,
predictors, and outcomes. Crit Care Med. Jan 2004;32(1):88-93.
47. De Weerdt A, Snoeckx A, Germonpre P, Jorens PG. Rapid-on¬set adult respiratory distress syndrome after activated charcoal aspiration. A pitch-black tale of a potential to kill. Am J Respir Crit Care Med. Feb 1 2015;191(3):344-345.
48. Dorrington CL, Johnson DW, Brant R, Multiple Dose Activated Charcoal Complication Study G. The frequency of complications associated with the use of multiple-dose activated charcoal. Ann Emerg Med. Mar 2003;41(3):370-377.
49. Orfanidou G, Chalkias A, Koutsovasilis A, Loizos G, Xanthos T. Activated charcoal may not be necessary in all oral overdoses of medication. Am J Emerg Med. Feb 2016;34(2):319-321.
50. Lobo-Machin I, Medina-Arana V, Delgado-Plasencia L, Bra¬vo-Gutierrez A, Burillo-Putze G. Activated carbon peritonitis. Cir Esp. Nov 2015;93(9):e107-109.
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