From the Guidelines
Activated charcoal can be given in organophosphate poisoning, particularly within the first hour after ingestion, as part of comprehensive management. The recommended dose is typically 1 g/kg body weight (usually 50-100 g for adults) mixed with water to form a slurry 1. Activated charcoal works by adsorbing the organophosphorus compounds in the gastrointestinal tract, preventing their absorption into the bloodstream. However, it's essential to note that activated charcoal is most effective when administered early and should be considered as just one component of comprehensive management, which should also include:
- Airway protection
- Atropine administration, as recommended by the American Heart Association for patients with life-threatening organophosphate or carbamate poisoning 1
- Oximes like pralidoxime, which may be used for organophosphate poisoning, although the evidence is not as strong 1
- Supportive care
Activated charcoal is contraindicated in patients with:
- An unprotected airway
- Gastrointestinal perforation
- When the risk of aspiration is high
Multiple doses of activated charcoal are generally not recommended for organophosphorus poisoning as they provide limited additional benefit and may interfere with other treatments. It's crucial to prioritize the patient's airway, breathing, and circulation, and consider early endotracheal intubation for life-threatening organophosphate or carbamate poisoning, as well as the administration of benzodiazepines to treat seizures and agitation 1. Consultation with a medical toxicologist or certified regional poison center is also recommended for guidance on the management of organophosphate poisoning 1.
From the Research
Administration of Activated Charcoal in Organophosphate Poisoning
- Activated charcoal can be given in cases of organophosphate (OP) poisoning, as it may help reduce the gastrointestinal absorption of the toxin 2, 3, 4, 5.
- The use of activated charcoal in OP poisoning is part of the supportive treatment, which includes rapid initial management of airways, breathing, and circulation 5.
- Activated charcoal should be given as soon as possible, preferably within 2 hours after ingestion of the OP compound, provided the patient is fully conscious and capable of swallowing safely 4.
- Gastric lavage and activated charcoal are routinely used decontamination procedures, but their value has not been conclusively proven in OP poisoning 5.
Efficacy of Activated Charcoal in OP Poisoning
- The effectiveness of activated charcoal in combating the signs and symptoms of OP poisoning has been shown in some studies 3.
- Activated charcoal can reduce the absorption of OP compounds from the gastrointestinal system, which may help alleviate the symptoms of poisoning 6, 4.
- However, the use of activated charcoal is not a substitute for other treatments, such as atropine and cholinesterase reactivators, which are specific for OP poisoning 2, 5.
Considerations for Administration
- The administration of activated charcoal should be considered on a case-by-case basis, taking into account the patient's condition, the severity of the poisoning, and the potential benefits and risks of treatment 4, 5.
- Activated charcoal is not recommended for patients who are unconscious or unable to swallow safely, as it may cause aspiration or other complications 4.