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Clinical Practice Guidelines

Use of Activated Charcoal in Poisonings


  • Statewide logo

    This guideline has been adapted for statewide use with the support of the Victorian Paediatric Clinical Network

  • 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.

     2.“Decontamination” 

    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:

    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: Parent information sheet 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