Activated charcoal for pediatric poisonings: The universal antidote?

Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35233, USA.
Current Opinion in Pediatrics (Impact Factor: 2.53). 05/2007; 19(2):216-22. DOI: 10.1097/MOP.0b013e32801da2a9
Source: PubMed


For decades, activated charcoal has been used as a 'universal antidote' for the majority of poisons because of its ability to prevent the absorption of most toxic agents from the gastrointestinal tract and enhance the elimination of some agents already absorbed. This manuscript will review the history of activated charcoal, its indications, contraindications, and the complications associated with its use as reported in the literature.
Recent randomized prospective studies, although with small numbers, have shown no difference in length of hospital stay, morbidity, and mortality between groups who received and did not receive activated charcoal. No study has had sufficient numbers to satisfactorily address clinical outcome in patients who received activated charcoal less than 1 h following ingestion.
If used appropriately, activated charcoal has relatively low morbidity. Due to the lack of definitive studies showing a benefit in clinical outcome, it should not be used routinely in ingestions. AC could be considered for patients with an intact airway who present soon after ingestion of a toxic or life-threatening dose of an adsorbable toxin. The appropriate use of activated charcoal should be determined by the analysis of the relative risks and benefits of its use in each specific clinical scenario.

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    • "Activated charcoal (AC) may be used but its efficacy is controversial in case of mercury poisoning. The usual oral dose of AC is 0.5-1 gr/kg, with a maximum dose of 100 gr [69]. Many organic and inorganic contaminants are removed with this method [70]. "
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    ABSTRACT: Mercury poisoning cases have been reported in many parts of the world, resulting in many deaths every year. Mercury compounds are classified in different chemical types such as elemental, inorganic and organic forms. Long term exposure to mercury compounds from different sources e.g. water, food, soil and air lead to toxic effects on cardiovascular, pulmonary, urinary, gastrointestinal, neurological systems and skin. Mercury level can be measured in plasma, urine, feces and hair samples. Urinary concentration is a good indicator of poisoning of elemental and inorganic mercury, but organic mercury (e.g. methyl mercury) can be detected easily in feces. Gold nanoparticles (AuNPs) are a rapid, cheap and sensitive method for detection of thymine bound mercuric ions. Silver nanoparticles are used as a sensitive detector of low concentration Hg2+ ions in homogeneous aqueous solutions. Besides supportive therapy, British anti lewisite, dimercaprol (BAL), 2,3-dimercaptosuccinic acid (DMSA. succimer) and dimercaptopropanesulfoxid acid (DMPS) are currently used as chelating agents in mercury poisoning. Natural biologic scavengers such as algae, azolla and other aquatic plants possess the ability to uptake mercury traces from the environment.
    DARU Journal of Pharmaceutical Sciences 06/2014; 22(1):46. DOI:10.1186/2008-2231-22-46 · 1.64 Impact Factor
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    • "Activated charcoal (AC) has been used for gastric decontamination over the last century. It prevents absorption of substances in the gastrointestinal tract; thereby decreasing systemic absorption of potentially toxic agents [3]. Large reductions in drug absorption occur when AC is administered soon after drug ingestion [4]. "
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    ABSTRACT: Purpose of the study: Comparative in vitro studies were carried out to determine the adsorption characteristics of 3 drugs on activated charcoal (AC) and sodium polystyrene sulfonate (SPS). Activated charcoal (AC) has been long used as gastric decontamination agent for tricyclic antidepressants (TCA). Solutions containing drugs (amitriptyline, clomipramine, or doxepin) and variable amount of AC or SPS were incubated for 30 minutes. At pH 1.2 the adsorbent: drug mass ratio varied from 2 : 1 to 40 : 1 for AC, and from 0.4 : 1 to 8 : 1 for SPS. UV-VIS spectrophotometer was used for the determination of free drug concentrations. The qmax of amitriptyline was 0.055 mg/mg AC and 0.574 mg/mg SPS, qmax of clomipramine was 0.053 mg/mg AC and 0.572 mg/mg SPS, and qmax of doxepin was 0.045 mg/mg AC and 0.556 mg/mg SPS. The results of adsorption experiments with SPS revealed higher values for the qmax parameters in comparison with AC. In vitro gastric decontamination experiments for antidepressant amitriptyline, clomipramine, and doxepin showed that SPS has higher qmax values than the corresponding experiments with AC. Therefore, we suggest SPS is a better gastric decontaminating agent for the management of acute TCA intoxication.
    DARU-JOURNAL OF FACULTY OF PHARMACY 01/2014; 22(1):21. DOI:10.1186/2008-2231-22-21 · 1.64 Impact Factor
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    ABSTRACT: To evaluate the effectiveness of activated charcoal in alleviating Verrucarin J, two treated groups of 10 male albino mice were treated with a sublethal dose (0.9mg/kg body weight orally) for two weeks in combination with or without activated charcoal. Highly significant increase in plasma level of lipid peroxidation (LPO), liver disease is often clinically assessed using serum enzyme activites such as glutamate oxaloacetate transaminase (AST), glutamate pyruvate transaminase (ALT), γ-glutamyl transferase (γ-GT), alkaline phosphatase (ALP), the level of these enzymes were increased significantly in serum of treated group with Verrucarin J and significant decrease of plasma level of antioxidants enzymes and total thiols. In tissue homogenate of liver, level of thiobarbituric acid (TBARs) were significantly increases while activities of superoxide dismutase (SOD) and catalase (CAT) and hepatic glutathione were significantly decreased. Addition of charcoal (1g/kg) to Verrucarin J contaminated diets appeared the adverse effect of toxin. The result indicates that charcoal may be used as antioxidant and antidote for Verrucarin J in male albino mice.
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