From the Research
Activated charcoal should not be used in patients who have ingested corrosive substances, hydrocarbons, or have decreased level of consciousness without a protected airway, gastrointestinal obstruction, perforation, or ileus, as well as in cases where the substance ingested is poorly adsorbed by charcoal, including alcohols, lithium, iron, and other metals. The use of activated charcoal is contraindicated in several clinical scenarios due to its mechanism of action and potential risks. According to 1, the major causes of morbidity and mortality secondary to activated charcoal therapy are aspiration of charcoal, gastrointestinal obstruction, and fluid and electrolyte abnormalities. Some of the key contraindications for activated charcoal usage include:
- Ingestion of corrosive substances (strong acids or alkalis) as it does not bind these effectively and may obscure endoscopic evaluation of damage
- Ingestion of hydrocarbons like petroleum distillates, as the risk of aspiration outweighs potential benefits
- Decreased level of consciousness without a protected airway due to aspiration risk
- Gastrointestinal obstruction, perforation, or ileus, as activated charcoal may worsen these conditions
- Ingestions of substances it poorly adsorbs, including alcohols (ethanol, methanol, isopropyl alcohol), lithium, iron, lead, potassium, sodium, and other metals, as administration of activated charcoal may be futile and potentially delay more appropriate treatments. Additionally, repeated doses of activated charcoal may cause constipation or bowel obstruction, particularly in dehydrated patients or those with reduced gut motility, as noted in 2. It is essential to consider these contraindications and potential risks when deciding whether to administer activated charcoal, prioritizing the patient's morbidity, mortality, and quality of life.