From the Guidelines
Activated charcoal should be administered through an NG tube as a 1:8 dilution (1 part charcoal to 8 parts water) to effectively deliver the charcoal to adsorb toxins in the gastrointestinal tract without clogging the tube. The standard dose for acute ingestion of selected toxic substances is 1–2 g/kg PO or nasogastrically, with an adolescent/adult dose of 50–100 g 1. Before administration, it is crucial to verify proper NG tube placement and ensure the patient has a protected airway, particularly if they have an altered mental status. Key considerations for administration include:
- Mixing the charcoal powder with water to achieve the 1:8 dilution
- Using 400-800mL of water for a standard adult dose of 50-100g of activated charcoal powder
- Shaking the mixture well immediately before administration as charcoal settles quickly
- Administering the solution slowly over 15-30 minutes to minimize the risk of vomiting and aspiration
- Flushing the NG tube with 50-100mL of water after administration to prevent clogging It is also important to note that consultation with a poison center/clinical toxicologist is strongly encouraged before use, and certain substances like iron, lithium, alcohols, ethylene glycol, alkalis, fluoride, mineral acids, and potassium are not bound by activated charcoal 1.
From the FDA Drug Label
Directions 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. The administration protocol for activated charcoal through a Nasogastric (NG) tube for dilution is to mix 3 to 4 heaping tablespoonfuls (20 to 30 g) of activated charcoal in a minimum of 8 ounces of liquid.
- The exact protocol for NG tube administration is not specified in the label, but the general dilution guideline is provided. 2
From the Research
Administration Protocol for Activated Charcoal
- The administration of activated charcoal through a Nasogastric (NG) tube is a method used for dilution in cases of poisoning 3, 4.
- According to the studies, the recommended dose of activated charcoal for adults is 50 to 100g, and for children, it is about 1 g/kg 5.
- The administration of activated charcoal should be done as soon as possible, preferably within one hour of ingestion, to maximize its effectiveness 3, 6.
- The use of gastric emptying in addition to activated charcoal is not recommended as a routine approach, but it may be considered in certain circumstances, such as symptomatic patients presenting in the first hour after ingestion or patients who have ingested agents that slow gastrointestinal motility 7.
- It is essential to note that activated charcoal is not harmless and can cause complications, such as obstructive laryngitis, especially when administered through a Nasogastric tube 4.
Key Considerations
- The effectiveness of activated charcoal decreases with time, and its administration is most beneficial when done soon after ingestion 3, 6.
- The use of activated charcoal is recommended 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 7.
- The administration of activated charcoal through a Nasogastric tube requires careful consideration of the potential risks and benefits, and it should only be done by trained healthcare professionals 4.