Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Activated charcoal for pediatric poisonings:
the universal antidote?
Robert Michael Lapus
Purpose of review
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 thecomplications associatedwithits
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 1h 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.
antidote, charcoal, decontamination, ingestion, overdose,
Curr Opin Pediatr 19:216–222. ? 2007 Lippincott Williams & Wilkins.
Division of Pediatric Emergency Medicine, Department of Pediatrics, University of
Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
Correspondence to Robert Michael Lapus MD, Division of Pediatric Emergency
Medicine, Department of Pediatrics, University of Alabama at Birmingham School
of Medicine, 1600 7th Ave South Midtown Center 205, Birmingham, AL 35233,
Tel: +1 205 939 9587; fax: +1 205 475 4623; e-mail: email@example.com
Current Opinion in Pediatrics 2007, 19:216–222
multiple dose activated charcoal
single dose activated charcoal
? 2007 Lippincott Williams & Wilkins
According to the American Association of Poison Control
poison exposures, 1.9 million of which were due to
ingestion [1?]. About 93% of these occurred in the home
and slightly more than half of the 2.4 million cases
involved children less than 6years of age. For all groups,
most cases (77%) were managed in a nonhealthcare
facility and 22.4% of cases were treated in a healthcare
facility. In children less than 6years of age, 10.2%
were treated in a healthcare facility. Although they
comprise the majority of calls to the poison centers,
children less than 6years of age accounted for 2.3% of
were 1183 reported fatalities, 75% were due to toxin
ingestion and 77.7% were intentional [1?]. Thus, poison-
ing still remains a significant cause of morbidity in the
pediatric age group. Activated charcoal has always been
associated with treatment for poisonings, although, per-
haps, this perception/practice should change based on
Activated charcoal has been used for the last century for
gastric decontamination. It prevents absorption of sub-
stances in the gastrointestinal tract, thereby decreasing
systemic absorption of potentially toxic agents. In the
past it had been referred to as ‘the universal antidote’;
however, its use has been slowly declining from a peak
use of 7.7% in 1995 to 5.6% in 2004. Further, more and
more is being reported about its adverse effect profile,
such as the potential to lead to bowel obstruction or
aspiration pneumonitis. Is charcoal truly the ‘universal
antidote’ or will it go the way of ‘the medical anecdote’?
The purpose of this article is to review the history of
activated charcoal, discuss its indications, contraindica-
tions, and review the complications associated with its
use as reported in the literature.
History of activated charcoal in medicine
Charcoal has been used for medical purposes for thou-
sands of years. The Egyptian papyri document the use of
charcoal to 1500 BC . The ancient Egyptians used
charcoal to adsorb the odor from rotting wounds. Hindu
documents from 450 BC record the use of charcoal
and sand filters for the purification of drinking water.
In 400 BC, Hippocrates and Pliny used charcoal to treat
epilepsy, chlorosis, and anthrax. In 157 BC, Claudius
Galvanometer wrote 500 treatises, some about the
use of carbon for medical purposes. In 1773, Scheele
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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