Charcoal (Activated)

ADMINISTRATION ROUTES:

PO, NG

ALTERNATIVE NAMES:

Carbosorb X (does not contain sorbitol), carbosorb XS (contains sorbitol)

ICU INDICATIONS:

1. Single dose activated charcoal is indicated where it is likely that toxin remains in the gastrointestinal tract (i.e. within one hour of ingestion for most agents) and where the potential benefits outweigh the potential risk
2. Multiple dose activated charcoal may be indicated for agents that undergo enterohepatic recirculation and are adsorbed by activated charcoal. Such agents are:

• Carbamazepine
• Dapsone
• Phenobarbitone
• Quinine
• Theophylline

PRESENTATION AND ADMINISTRATION:

PO / NG:

Carbosorb XS contains 50 gm activated charcoal and 99.8g of sorbitol in 250 mL Carbosorb X contains 50 gm activated charcoal in 250 mL

Give to the patient in a cup for self administration. If the patient is unable to swallow, administer via nasogastric tube if present and the correct tube position has been confirmed radiologically

Note: there are no data to support the use of activated charcoal in sorbitol or other cathartic over activated charcoal in water (generally, therefore, carbosorb X is preferred)

DOSAGE:

PO:

Single dose:

50 gm

Multiple dose:

Initial dose 50 gm then repeat doses of 25 gm every 2 hours

Check for bowel sounds prior to administration of each dose and cease administration if bowel sounds are absent. Reconsider the indication every 6 hours

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

PO:

Single dose:

Age >1 month give 1 gm/kg (max 50g)

Multiple dose:

Initial dose 1 gm/kg then repeat doses of 0.5 gm/kg every 2 hours

Check for bowel sounds prior to administration of each dose and cease administration if bowel sounds are absent. Reconsider the indication every 6 hours

CLINICAL PHARMACOLOGY:

Carbosorb X (does not contain sorbitol), carbosorb XS (contains sorbitol). Charcoal is an adsorbent. Sorbitol is a cathartic.

Activated charcoal is produced by super-heating of distilled wood pulp. The resulting fine porous particles are suspended in water (or sorbitol). The particles have a very large surface area and readily absorb most ingested toxins in the gastrointestinal tract.

CONTRAINDICATIONS:

1. Decreased level of consciousness without airway protection
2. Bowel obstruction
3. Intoxication due to a substance that is not adsorbed by charcoal (i.e hydrocarbons, alcohols, metals and corrosives)
4. Non-toxic ingestion or sub-toxic dose

Note: if mental status precludes self-administration, activated charcoal should be withheld until the patient is intubated if and when this becomes clinically necessary. Only in rare circumstances does the risk assessment justify intubation specifically to administer charcoal.

WARNINGS:

Do not use activated charcoal if risk assessment suggests the potential for imminent onset of seizures or the potential for a rapid decrease in conscious state

PRECAUTIONS:

General:

Activated charcoal may lead to impaired absorption of medications administered via the oral route

Laboratory Tests:

No tests in addition to routine ICU tests are required

Drug/Laboratory Test Interactions:

None known

IMPORTANT DRUG INTERACTIONS IN ICU:

Activated charcoal may lead to impaired absorption of medications administered via the oral route

ADVERSE REACTIONS:

Respiratory System:

Pulmonary aspiration of charcoal (especially if decreased conscious state or seizures)

Digestive System:

Vomiting, constipation, charcoal bezoar formation, perforation, obstruction