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See also

Poisoning – Acute Guidelines for initial management��
Anticonvulsant poisoning��
Tricyclic Antidepressant (TCA) poisoning��
Salicylates poisoning

For 24 hour advice, contact the Victorian Poisons Information Centre on 13 11 26 ��

Key points

1. Activated charcoal has a very limited role in the treatment of childhood poisoning. It should not be used without consultation with a toxicologist��
2. Aspiration of activated charcoal can cause significant morbidity and mortality. Nasogastric tube position must be confirmed on chest X-ray before administering activated charcoal
3. If indicated, activated charcoal should be administered as soon as possible, usually within 1 to 2 hours of the exposure��

Background��

Activated��charcoal is very rarely indicated in children.�� It should only be used in potentially severe poisonings where supportive care and antidote therapy alone would result in a poor outcome, ie where the benefits outweigh the potential risks

Activated charcoal is a form of carbon that binds to many drugs and toxins, reducing further absorption from the gastrointestinal tract and increasing elimination of some drugs (‘gastrointestinal dialysis’) if multiple doses of charcoal are given��

Investigations:

Specific drug concentrations may be measured, although these results (and other blood tests) would return too late to influence the early consideration of Charcoal��

Acute Management��

1. Resuscitation

Standard procedures and supportive care

��Although charcoal should be administered early after ingestions, it should only be administered after appropriate resuscitation has been administered

��Intubation and ventilation may be required prior to administration.

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1. ��Activated Charcoal has a very limited role in treatment and should not be used without consultation with a toxicologist.��
2. Consider activated Charcoal ��if the patient presents early (for example 1-2 hours) after a potentially severe toxic ingestion (see Table 1)

Table 1: List of selected toxins where activated charcoal may be considered:

• Amisulpride
• , particularly verapamil and diltiazem
• Carbamazepine
• Colchicine
• Beta Blockers
• Methotrexate Paraquat/diquat

Activated Charcoal may need to be considered for other drugs, see individual poisoning guidelines and discuss with toxicologist.

When is Activated Charcoal contraindicated?

Patients with altered/reduced conscious state or at imminent risk of seizures and with unprotected airway��

Table 2: List of toxins where Charcoal is NOT helpful and contraindicated

• Acid,and Alkalis / corrosives
• Cyanide
• Ethanol/methanol/glycols
• Eucalyptus and Essential Oils
• Fluoride
• Hydrocarbons
• Metals - including Lithium, Iron compounds, potassium, lead
• Mineral acids - Boric acid

Adverse Effects:��

• Respiratory - aspiration, progressive respiratory failure; Death.
• Beware oral use with drowsiness, or following the ingestion of substances which could cause rapidly reduced CNS depression or may cause seizures
• Faecal discolouration
• GI obstruction: by bezoar formation��

Administration:

• highly viscous and dilution ratio varies
• minimum of 0.25 parts water:1 part of activated charcoal
• use large bore NG tube eg 10-14 French gauge

Multi dose activated charcoal:

Whilst there is evidence of a pharmacokinetic effect, it is not evident that repeating doses of charcoal improves clinical outcome. Multiple dose activated charcoal should be ceased immediately if bowel sounds disappear

If repeating multiple doses of activated charcoal, consider measuring drug concentrations, as well as monitoring the patients clinical condition

In particular, there is some evidence for repeating Charcoal for life threatening ingestions of carbamazepine, dapsone, phenobarbitone, phenytoin, quinine or theophylline ��

When to admit/consult local paediatric team, or who/when to phone

Admission should be considered for all adolescent patients with an intentional overdose��

For 24 hour advice, contact the Victorian Poisons Information Centre on 13 11 26��

When to consider transfer to a tertiary centre

For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.�� ��

Discharge Criteria

See individual poisoning guidelines as appropriate�� ��

Parent information��

Accidental ingestion: from Victorian Poisons Information centre on the prevention of poisoning��

Intentional self –harm: Referral to local mental health services eg Orygen Youth Health:��1800 888 320����

Recreational poisoning: Referral to YoDAA, Victoria's��Youth��Drug and��Alcohol��Advice service: 1800 458 685�� ��

Last updated June 2017