What is the proper administration protocol for activated charcoal (AC)?

From the Guidelines

Activated charcoal should be administered as soon as possible after toxic ingestion, ideally within 1 hour but may be beneficial up to 4 hours post-ingestion, at a standard dose of 1g/kg orally, in a slurry, as stated in the management of acetaminophen hepatotoxicity 1. The administration protocol for activated charcoal (AC) involves oral ingestion, with the option to use a nasogastric tube in uncooperative patients or those with decreased consciousness, ensuring proper airway protection. Key considerations for administration include:

• Ensuring the patient has a protected airway and is not at risk for aspiration
• Contraindications for caustic ingestions, intestinal obstruction, and substances that AC poorly adsorbs, such as alcohols, metals, and hydrocarbons, as noted in the guidelines for cardiac arrest in special situations 1
• Potential for multiple doses in cases of toxins with enterohepatic circulation
• Common side effects, including black stools, vomiting, and constipation, with cautious use of cathartics like sorbitol to avoid electrolyte imbalances. The primary mechanism of action for AC is adsorbing toxins in the gastrointestinal tract, preventing their absorption into the bloodstream, which is crucial in managing toxic ingestions, including acetaminophen hepatotoxicity 1.

From the FDA Drug Label

When Activated Charcoal is indicated for use, give 3 to 4 heaping tablespoonfulls (20 to 30 g) mixed in a minimum of 8 ounces of liquid or as directed by a health professional. Directions for 8 oz bottle When Activated Charcoal is indicated, the usual dose is as follows: 0-10 years of age: 1 to 3 heaping tablespoonfulls (10 -25 g) mixed in a minimum of 8 ounces of liquid. 10 - 12 yrs of age: 3 - 6 tablespoonfulls (25 - 50 g) mixed in a minimum of 8 ounces of liquid. Greater than 12 years of age: 3 to 12 tablespoonfulls (25 - 100g) mixed with a minimum of 8 ounces of liquid or as directed by a health professional.

The proper administration protocol for activated charcoal (AC) is to give the following doses mixed in a minimum of 8 ounces of liquid:

• For adults and children over 12 years: 3 to 12 tablespoonfuls (25 - 100g)
• For children 10-12 years: 3 - 6 tablespoonfuls (25 - 50 g)
• For children 0-10 years: 1 to 3 heaping tablespoonfuls (10 -25 g) or as directed by a health professional 2, 2. Key warnings:
• Do not give Activated Charcoal until after patient has vomited unless directed by a health professional.
• Do not use in persons who are not fully conscious.
• Do not use this product unless directed by a health professional if certain substances have been ingested 2.

From the Research

Administration Protocol for Activated Charcoal

The proper administration protocol for activated charcoal (AC) involves several key considerations:

• Activated charcoal can be administered up to 2 hours after the ingestion of a toxic substance, unless there are contra-indications 3.
• Multiple-dose activated charcoal in combination with a laxative can be administered in cases of overdose with toxins that use the enterohepatic circulation 3.
• The use of activated charcoal is recommended as soon as possible after emergency department presentation, unless the agent and quantity are known to be nontoxic, the agent is known not to adsorb to activated charcoal, or the delay has been so long that absorption is probably complete 4.
• Activated charcoal should be given in the home, emergency vehicle, or immediately upon admission to maximize its efficacy 5.

Contra-Indications and Precautions

Certain situations require caution or contra-indicate the use of activated charcoal:

• Activated charcoal should not be administered if there are indications that the toxin will not bind to activated charcoal or that the amount of toxin that the patient has ingested is too great 3.
• Gastric lavage should be limited to extremely serious intoxication, when the substance has been ingested less than 1-2 hours previously 3.
• Accidental administration of activated charcoal into the lung can occur, and precautions should be taken to avoid this complication 6.

Combination with Other Treatments

The use of activated charcoal in combination with other treatments, such as gastric emptying, is a topic of debate:

• Several large comparative studies have failed to demonstrate a benefit of gastric emptying before activated charcoal 4.
• Gastric emptying in addition to activated charcoal cannot be considered the routine approach to patients, due to the risk of complications such as intubation, aspiration, and ICU admission 4.
• However, there may be certain circumstances in which gastric emptying in addition to activated charcoal is beneficial, such as in symptomatic patients presenting in the first hour after ingestion 4.