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 evidenced by the management of acetaminophen hepatotoxicity 1. The administration of activated charcoal is a crucial step in the management of toxic ingestions, particularly for substances like acetaminophen, which is a leading cause of acute liver failure 1.
- Key considerations for administration include:
- Timing: Activated charcoal is most effective when given within 1 hour of ingestion, but may still be beneficial up to 3 to 4 hours after ingestion 1.
- Dosing: The standard dose is 1g/kg orally, in a slurry, which can be administered orally or via nasogastric tube.
- Indications: Activated charcoal is effective for medications like acetaminophen, and its administration does not reduce the effect of N-acetylcysteine, an antidote for acetaminophen poisoning 1.
- It is essential to note that activated charcoal may not be effective for all types of ingestions, and its use should be considered on a case-by-case basis, taking into account the specific substance ingested and the time elapsed since ingestion 1.
From the Research
Administration of Activated Charcoal
The administration of activated charcoal is a method used for gastric decontamination in cases of poisoning or overdose.
- The American Academy of Clinical Toxicology, European Association of Poisons Centres, and Clinical Toxicologists recommend administration of activated charcoal within one hour of an acute toxic ingestion 2.
- The effectiveness of activated charcoal decreases with time, with the greatest benefit within one hour of ingestion 3, 4.
- Single-dose activated charcoal should not be administered routinely in the management of poisoned patients, but may be considered if a patient has ingested a potentially toxic amount of a poison up to one hour previously 3, 4.
- There is no evidence that the administration of activated charcoal improves clinical outcome 3, 4, 5.
- Unless a patient has an intact or protected airway, the administration of charcoal is contraindicated 3, 4.
Timing of Administration
- The administration of activated charcoal is most effective when given within the first hour of poison ingestion 2, 3, 4, 5.
- If administration is delayed, the effectiveness of activated charcoal decreases, but the potential for benefit after one hour cannot be excluded 3, 4.
- In pre-hospital settings, administration of activated charcoal within 60 minutes of an acute overdose is possible, with 28% of patients receiving it in this timeframe 2.
Special Considerations
- Children older than 12 months can be given syrup of ipecac at home, while most children who reach hospital can be treated with charcoal alone 6.
- Adults are typically managed with supportive care and, in the absence of contraindications, a single dose of activated charcoal if seen within four hours of ingestion of the poison or drug 6.
- Gastric lavage is used if the patient presents within one hour of ingestion and has clinical features of toxicity 6.