Clinical Pediatric Emergency Medicine
Volume 6, Issue 2 , Pages 76-80 , June 2005

Activated Charcoal Revisited

  • Pierre Gaudreault, MD, FRCPC

      Affiliations

    • Corresponding Author InformationReprint requests and correspondence: Pierre Gaudreault, MD, FRCPC, Department of Pediatrics, University of Montreal, Montreal, Quebec H3T 1C5, Canada.

References 

  1. Andersen A. Experimental studies on the pharmacology of activated charcoal: I. Adsorption power of charcoal in aqueous solutions. Acta Pharmacol. 1946;2:69–78
  2. Chyka PA, Seger D. Position statement: single-dose activated charcoal. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol. 1997;35:721–741
  3. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. Position statement and practice guidelines on the use of multi-dose activated charcoal in the treatment of acute poisoning. J Toxicol Clin Toxicol. 1999;37:731–751
  4. Holt LE, Holz PH. The black bottle: a consideration of the role of charcoal in the treatment of poisoning in children. J Pediatr. 1963;63:306–314
  5. Bradberry SM, Vale JA. Multiple-dose activated charcoal: a review of relevant clinical studies. J Toxicol Clin Toxicol. 1995;33:407–416
  6. Neuvonen PJ. Clinical pharmacokinetics of oral activated charcoal in acute intoxications. Clin Pharmacokinet. 1982;7:465–489
  7. Albertson TE, Derlet RW, Foulke GE, et al. Superiority of activated charcoal alone compared with ipecac and activated charcoal in the treatment of acute toxic ingestions. Ann Emerg Med. 1989;18:56–59
  8. Buckley NA, Whyte IM, O'Connell DL, Dawson AH. Activated charcoal reduces the need for N-acetylcysteine treatment after acetaminophen (paracetamol) overdose. J Toxicol Clin Toxicol. 1999;37:753–757
  9. Kulig K, Bar-Or D, Cantrill SV, et al. Management of acutely poisoned patients without gastric emptying. Ann Emerg Med. 1985;14:562–567
  10. Campbell JW, Chyka PA. Physicochemical characteristics of drugs and response to repeat-dose activated charcoal. Am J Emerg Med. 1992;10:208–210
  11. Chyka PA, Holley JE, Mandrell TD, Sugathan P. Correlation of drug pharmacokinetics and effectiveness of multiple-dose activated charcoal therapy. Ann Emerg Med. 1995;25:356–362
  12. McLuckie A, Forbes AM, Ilett KF. Role of repeated doses of oral activated charcoal in the treatment of acute intoxications. Anaesth Intensive Care. 1990;18:375–384
  13. Decker WJ, Combs HF, Corby DG. Adsorption of drugs and poisons by activated charcoal. Toxicol Appl Pharmacol. 1968;13:454–460
  14. Favin FD, Klein-Schwartz W, Oderda GM, Rose SR. In vitro study of lithium carbonate adsorption by activated charcoal. J Toxicol Clin Toxicol. 1988;26:443–450
  15. Minocha A, Herold DA, Barth JT, et al. Activated charcoal in oral ethanol absorption: lack of effect in humans. J Toxicol Clin Toxicol. 1986;24:225–234
  16. Neuvonen PJ, Olkkola KT. Oral activated charcoal in the treatment of intoxications. Role of single and repeated doses. Med Toxicol Adverse Drug Exp. 1988;3:33–58
  17. Lambert RJ, Kindler BL, Schaeffer DJ. The efficacy of superactivated charcoal in treating rats exposed to a lethal oral dose of potassium cyanide. Ann Emerg Med. 1988;17:595–598
  18. Olkkola KT, Neuvonen PJ. Do gastric contents modify antidotal efficacy of oral activated charcoal?. Br J Clin Pharmacol. 1984;18:663–669
  19. Neuvonen PJ, Olkkola KT, Alanen T. Effect of ethanol and pH on the adsorption of drugs to activated charcoal: studies in vitro and in man. Acta Pharm Toxicol. 1984;54:1–7
  20. Andersen A. Experimental studies on the pharmacology of activated charcoal: II. The effect of pH on the adsorption by charcoal from aqueous solutions. Acta Pharmacol. 1947;3:199–218
  21. Andersen A. Experimental studies on the pharmacology of activated charcoal: III. Adsorption from gastric contents. Acta Pharmacol. 1948;4:275–284
  22. Tenenbein M, Cohen S, Sitar DS. Efficacy of ipecac-induced emesis, orogastric lavage, and activated charcoal for acute drug overdose. Ann Emerg Med. 1987;16:838–841
  23. Levy G, Tsuchiya T. Effect of activated charcoal on aspirin absorption in man: Part I. Clin Pharmacol Ther. 1972;13:317–322
  24. Filippone GA, Fish SS, Lacouture PG, et al. Reversible adsorption (desorption) of aspirin from activated charcoal. Arch Intern Med. 1987;147:1390–1392
  25. Osterhoudt KC, Durbin D, Alpern ER, Henretig FM. Risk factors for emesis after therapeutic use of activated charcoal in acutely poisoned children. Pediatrics. 2004;113:806–810
  26. Dorrington CL, Johnson DW, Brant R. The frequency of complications associated with the use of multiple-dose activated charcoal. Ann Emerg Med. 2003;41:370–377
  27. Elliott CG, Colby TV, Kelly TM, Hicks HG. Charcoal lung. Bronchiolitis obliterans after aspiration of activated charcoal. Chest. 1989;96:672–674
  28. Givens T, Holloway M, Wason S. Pulmonary aspiration of activated charcoal: a complication of its misuse in overdose management. Pediatr Emerg Care. 1992;8:137–140
  29. Justiniani JR, Hippalgaonkar R, Martinez LO. Charcoal-containing empyema complicating treatment for overdose. Chest. 1985;87:404–405
  30. Menzies DG, Busuttil A, Prescott LF. Fatal pulmonary aspiration of oral activated charcoal. BMJ. 1988;297:459–460
  31. Pollack MM, Dunbar BS, Holbrook PR, Fields AI. Aspiration of activated charcoal and gastric contents. Ann Emerg Med. 1981;10:528–529
  32. Mariani PJ, Pook N. Gastrointestinal tract perforation with charcoal peritoneum complicating orogastric intubation and lavage. Ann Emerg Med. 1993;22:606–609
  33. Brubacher JR, Levine B, Hoffman RS. Intestinal pseudo-obstruction (Ogilvie's syndrome) in theophylline overdose. Vet Hum Toxicol. 1996;38:368–370
  34. Longdon P, Henderson A. Intestinal pseudo-obstruction following the use of enteral charcoal and sorbitol and mechanical ventilation with papaveretum sedation for theophylline poisoning. Drug Saf. 1992;7:74–77
  35. Goulbourne KB, Cisek JE. Small-bowel obstruction secondary to activated charcoal and adhesions. Ann Emerg Med. 1994;24:108–110
  36. Ray MJ, Radin DR, Condie JD, et al. Charcoal bezoar. Small-bowel obstruction secondary to amitriptyline overdose therapy. Dig Dis Sci. 1988;33:106–107
  37. Watson WA, Cremer KF, Chapman JA. Gastrointestinal obstruction associated with multiple-dose activated charcoal. J Emerg Med. 1986;4:401–407
  38. de Silva HA, Fonseka MM, Pathmeswaran A, et al. Multiple-dose activated charcoal for treatment of yellow oleander poisoning: a single-blind, randomised, placebo-controlled trial. Lancet. 2003;361:1935–1938
  39. Tenenbein M. Multiple doses of activated charcoal: time for reappraisal?. Ann Emerg Med. 1991;20:529–531
  40. Levy G, Soda DM, Lampman TA. Inhibition by ice cream of the antidotal efficacy of activated charcoal. Am J Hosp Pharm. 1975;32:289–291
  41. Manes M, Mann JP. Easily swallowed formulations of antidote charcoals. Clin Toxicol. 1974;7:355–364
  42. Cooney DO. Palatability of sucrose-, sorbitol-, and saccharin-sweetened activated charcoal formulations. Am J Hosp Pharm. 1980;37:237–239
  43. Dagnone D, Matsui D, Rieder MJ. Assessment of the palatability of vehicles for activated charcoal in pediatric volunteers. Pediatr Emerg Care. 2002;18:19–21
  44. Eisen TF, Grbcich PA, Lacouture PG, et al. The adsorption of salicylates by a milk chocolate-charcoal mixture. Ann Emerg Med. 1991;20:143–146
  45. Navarro RP, Navarro KR, Krenzelok EP. Relative efficacy and palatability of three activated charcoal mixtures. Vet Hum Toxicol. 1980;22:6–9
  46. Gwilt PR, Perrier D. Influence of “thickening” agents on the antidotal efficacy of activated charcoal. Clin Toxicol. 1976;9:89–92
  47. al-Shareef AH, Buss DC, Allen EM, Routledge PA. The effects of charcoal and sorbitol (alone and in combination) on plasma theophylline concentrations after a sustained-release formulation. Hum Exp Toxicol. 1990;9:179–182
  48. Keller RE, Schwab RA, Krenzelok EP. Contribution of sorbitol combined with activated charcoal in prevention of salicylate absorption. Ann Emerg Med. 1990;19:654–656
  49. Mathur LK, Jaffe JM, Colaizzi JL, Moriarty RW. Activated charcoal-carboxymethylcellulose gel formulation as an antidotal agent for orally ingested aspirin. Am J Hosp Pharm. 1976;33:717–719
  50. McNamara RM, Aaron CK, Gemborys M, Davidheiser S. Sorbitol catharsis does not enhance efficacy of charcoal in a simulated acetaminophen overdose. Ann Emerg Med. 1988;17:243–246
  51. Park GD, Spector R, Goldberg MJ, et al. Effect of the surface area of activated charcoal on theophylline clearance. J Clin Pharmacol. 1984;24:289–292
  52. Mofenson HC, Caraccio TR. Magnesium intoxication in a neonate from oral magnesium hydroxide laxative. J Toxicol Clin Toxicol. 1991;29:215–222
  53. Smilkstein MJ, Smolinske SC, Kulig KW, Rumack BH. Severe hypermagnesemia due to multiple-dose cathartic therapy. West J Med. 1988;148:208–211
  54. Farley TA. Severe hypernatremic dehydration after use of an activated charcoal-sorbitol suspension. J Pediatr. 1986;109:719–722
  55. Krenzelok EP, McGuigan M, Lheur P. Position statement: ipecac syrup. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol. 1997;35:699–709
  56. American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Poison treatment in the home. Pediatrics. 2003;112:1182–1185
  57. Lamminpaa A, Vilska J, Hoppu K. Medical charcoal for a child's poisoning at home: availability and success of administration in Finland. Hum Exp Toxicol. 1993;12:29–32
  58. Scharman EJ, Cloonan HA, Durback-Morris LF. Home administration of charcoal: can mothers administer a therapeutic dose?. J Emerg Med. 2001;21:357–361
  59. Spiller HA, Rodgers GC. Evaluation of administration of activated charcoal in the home. Pediatrics. 2001;108:e100
  60. Pond S, Jacobs M, Marks J, et al. Treatment of digitoxin overdose with oral activated charcoal. Lancet. 1981;2:1177–1180
  61. Pond SM, Olson KR, Osterloh JD, Tong TG. Randomized study of the treatment of phenobarbital overdose with repeated doses of activated charcoal. JAMA. 1984;251:3104–3108
  62. Neuvonen PJ, Elonen E, Mattila MJ. Oral activated charcoal and dapsone elimination. Clin Pharmacol Ther. 1980;27:823–827
  63. Berg MJ, Berlinger WG, Goldberg MJ, et al. Acceleration of the body clearance of phenobarbital by oral activated charcoal. N Engl J Med. 1982;307:642–644
  64. du Souich P, Caille G, Larochelle P. Enhancement of nadolol elimination by activated charcoal and antibiotics. Clin Pharmacol Ther. 1983;33:585–590
  65. Berlinger WG, Spector R, Goldberg MJ, et al. Enhancement of theophylline clearance by oral activated charcoal. Clin Pharmacol Ther. 1983;33:351–354
  66. Hillman RJ, Prescott LF. Treatment of salicylate poisoning with repeated oral charcoal. BMJ. 1985;291:1472
  67. Honcharik N, Anthone S. Activated charcoal in acute cyclosporin overdose. Lancet. 1985;1:1051
  68. Karkkainen S, Neuvonen PJ. Effect of oral charcoal and urine pH on dextropropoxyphene pharmacokinetics. Int J Clin Pharmacol Ther Toxicol. 1985;23:219–225
  69. Neuvonen PJ, Elonen E. Effect of activated charcoal on absorption and elimination of phenobarbitone, carbamazepine and phenylbutazone in man. Eur J Clin Pharmacol. 1980;17:51–57
  70. Levy G. Gastrointestinal clearance of drugs with activated charcoal. N Engl J Med. 1982;307:676–678
  71. Mahutte CK, True RJ, Michiels TM, et al. Increased serum theophylline clearance with orally administered activated charcoal. Am Rev Respir Dis. 1983;128:820–822
  72. Ohning BL, Reed MD, Blumer JL. Continuous nasogastric administration of activated charcoal for the treatment of theophylline intoxication. Pediatr Pharmacol. 1986;5:241–245

PII: S1522-8401(05)00055-8

doi: 10.1016/j.cpem.2005.04.005

Clinical Pediatric Emergency Medicine
Volume 6, Issue 2 , Pages 76-80 , June 2005