Details About Overdose or Poisoning Generic Salt ::  Charcoal, Activated

Charcoal, Activated

    

Drug Pharmacology ::

I. Pharmacology. Activatedcharcoal, by virtue of its large surface area, adsorbs many drugs andtoxins. Highly ionic salts (eg, iron, lithium, and cyanide) and smallpolar molecules (eg, alcohols) are poorly adsorbed. Repeated oral dosesof activated charcoal can increase the rate of elimination of somedrugs that have a small volume of distribution and that undergoenterogastric or enterohepatic recirculation (eg, digitoxin) or diffuseinto the GI lumen from the intestinal circulation (eg, phenobarbitaland theophylline). See also discussion in Section I, ComprehensiveEvaluation and Treatment. Co-administration with cathartics is ofunproven benefit and is associated with risks (see Section IV,Environmental and Occupational Toxicology).

Drug Indications ::

Indications

   

Activatedcharcoal is used orally after an ingestion to limit drug or toxinabsorption. Although traditionally given after the stomach has beenemptied by ipecac-induced emesis or gastric lavage, it is now morecommon practice and studies support that it may be used alone for mostingestions. However, evidence for benefit in the clinical setting doesnot exist, and some toxicologists advise against its routine use. Usein the home after a childhood exposure is controversial and of unprovenbenefit.

Repeateddoses of activated charcoal may be indicated to enhance elimination ofsome drugs if (1) more rapid elimination will benefit the patient (andthe benefits outweigh the risks of repeated doses; see IV.C and V.C,below) and (2) more aggressive means of removal (eg, hemodialysis andhemoperfusion) are not immediately indicated or available (seeRepeat-dose activated charcoal). However, it has not been proved toimprove patient outcome in clinical studies.

Repeateddoses of activated charcoal may be useful when the quantity of drug ortoxin ingested is greater than one-tenth of the usual charcoal dose(eg, an aspirin ingestion of more than 6–10 g) or when surface contactwith the drug is hindered (eg, pharmacobezoars and wrapped or packageddrugs).

Drug Contra-Indications ::

III. Contraindications./b>

   

Gastrointestinal ileus or obstruction may prevent the administration of more than one or two doses.

Acid or alkali ingestions unless other drugs have also been ingested (charcoal makes endoscopic evaluation more difficult).

Use of charcoal-sorbitol mixtures should be avoided in children (risk of hypernatremia and dehydration).

Obtunded patients at risk for aspiration of charcoal (need intact or protected airway).

Drug Adverse Effects ::

IV. Adverse effects

   

Constipation (may be prevented by coadministration of a cathartic).

Distension of the stomach, emesis (in particular if mixed with sorbitol) with potential risk of aspiration.

Diarrhea,dehydration, hypermagnesemia, and hypernatremia resulting fromcoadministered cathartics, especially with repeated doses of charcoaland cathartics or even after a single large dose of a premixedsorbitol-containing charcoal product.

Intestinal bezoar with obstruction (in particular with multidoses given to patients with impaired bowel motility).

E. Corneal abrasions have occurred when spilled in the eyes.

F. Use in pregnancy. Activatedcharcoal is not systemically absorbed. Diarrhea resulting in shock orhypernatremia in the mother could conceivably affect the fetusadversely.

Drug Lab Interactions ::

Drug or laboratory interactions

   

Activatedcharcoal may reduce, prevent, or delay the absorption of orallyadministered antidotes or other drugs (eg, acetylcysteine).

Theadsorptive capacity of activated charcoal may be diminished by theconcurrent ingestion of ice cream, milk, or sugar syrup; the clinicalsignificance is unknown but is probably minor.

Repeated doses of charcoal may enhance the elimination of some necessary therapeutic drugs (eg, anticonvulsants).

Drug Dose Management ::

Dosage and method of administration

   

Initial dose. Activatedcharcoal, 1 g/kg (adult dose 50–100 g; child < 5 years, 10–25 g)orally or via gastric tube, is administered, or if the quantity oftoxin ingested is known, 10 times the amount of ingested toxin byweight is given. For massive overdoses (eg, 60–100 g of aspirin), thismay need to be given in divided doses over 1–2 days.

Repeat-dose charcoal. Activatedcharcoal, 15–30 g (0.25–0.5 g/kg) every 2–4 hours or hourly (adults,average rate of 12.5 g/h; children, rate of 0.2 g/kg/h), is givenorally or by gastric tube. (The optimal regimen and dose are unknown,but more frequent dosing to include continuous gastric infusion may beadvantageous.) May administer a small dose of cathartic with everysecond or third charcoal dose (benefit is unproven). Do notuse a cathartic with every activated charcoal dose. Endpoints forrepeat-dose charcoal therapy include clinical improvement and decliningserum drug level; the usual empiric duration is 24–48 hours.

Forpatients with nausea or vomiting, administer antiemetics(metoclopramide, Metoclopramide, or ondansetron, Ondansetron) andconsider giving the charcoal by gastric tube.

Drug Chemical Formulations ::

Formulations

   

Thereare a variety of formulations and a large number of brands of activatedcharcoal. It is available as a powder, pellets, a liquid aqueoussuspension (preferable), and a liquid suspension in sorbitol orpropylene glycol.

The suggested minimum stocking levelto treat a 70-kg adult for the first 24 hours is three bottlescontaining 50 g of activated charcoal each. Preferred stock is theplain aqueous suspension.

Disclaimer ::

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