Activated Charcoal Flashcards
What clinical situation would indicate a need for activated charcoal?
The emergency treatment of acute oral poisoning and oral drug overdose
What is activated charcoal and how does it work?
It is a form of charcoal that has been treated to make it more porous.
When ingested, it remains in the gastrointestinal tract, allowing it to adsorb the ingested toxin and prevent it from being absorbed into the body.
Inclusion criteria for activated charcoal administration? (2)
Adults and children aged 1 yr and over who have ingested toxins less than 1 hour before attendance by an ambulance clinician.
Adults and children, irrespective of time of ingestion, who have ingested toxins and where the Toxbase or the National Poisons Information Service have been contacted and advised the administration of activated charcoal
Exclusion criteria for activated charcoal administration? (7)
Children aged under 1 year
Patient allergic to activated charcoal or any of its excipients
Patients presenting to the ambulance clinician more than 1 hour since ingestion of toxin unless Toxbase or National Poisons Information Service advise administration
Administration not advised following communication from Toxbase/NPIS
GCS less than 15, or likely to deteriorate below 15, whilst on scene or en-route to hospital
Patients who are vomiting
Patients with reduced gastro-intestinal motility (with a risk of obstruction) i.e. patients taking opioid medication or patients who have recently had abdominal surgery
The ingestion of what poisons should you not administer activated charcoal for? (6)
Cyanide
Petroleum distillates
Metal salts including salts of lithium and iron
Ethanol, methanol, ethylene glycol, iron salts, sodium chloride, lead boric acid, other mineral acid
Malathion
Corrosive substances
Why would you not administer activated charcoal after the ingestion of a corrosive substance?
Limited usefulness and hinders the visualisation of oesophageal burns or erosions
Cautions of activated charcoal administration? (3)
Aspiration of activated charcoal has been reported to cause airway obstruction and appropriate precautions should be taken to prevent aspiration, especially in small children
Activated charcoal will reduce the effectiveness of other orally administered antidotes
The presence of co-ingested alcohol together with a medication overdose does not preclude the administration of activated charcoal to absorb the medication overdose, as long as the alcohol consumed has not reduced the patient’s GCS below 15 and is not likely to do so prior to arrival at hospital
Side effects of activated charcoal administration? (5)
Bezoar formation (ball of material in the stomach that is not passed out)
Constipation
Diarrhoea
Black stools
Gastrointestinal obstruction or intestinal perforation (after multiple dosing)
Route of administration for activated charcoal?
Oral
Can be mixed with soft drinks to aid consumption
Adult dose of activated charcoal?
Single dose: 50g of activated charcoal
Paediatric dose of activated charcoal?
Children aged 1 year to under 12 years – 25g of activated charcoal unless a large quantity of intoxicant has been ingested, and where there is a risk to life. In these circumstances, the administration of the full 50g dose is indicated.
What referral arrangements and safety netting / advice should be provided to patients following the administration of activated charcoal?
Patient must be admitted to hospital
Advise receiving unit that patient has been given activated charcoal in case other oral antidotes are to be given
Advise patient of the potential side-effects and the need to alert the ambulance clinician if they begin to feel nauseous or think they are about to vomit
