Recommendations from the Clinical Toxicology Recommendations Collaborative on the administration of activated charcoal in acute oral overdose - PubMed
5 hours ago
- #Gastrointestinal Decontamination
- #Activated Charcoal
- #Poisoning Management
- Activated charcoal is not recommended for poisoning from arsenic, caesium, copper, ethanol, methanol, ethylene glycol, iron, lead, lithium, and metformin.
- Activated charcoal is appropriate for poisoning from antidysrhythmics, beta-adrenergic antagonists, bupropion, calcium-channel blockers, carbamazepine, cardiac glycosides, chloroquine, cocaine, colchicine, cyanide, dapsone, diphenhydramine, disopyramide, factor Xa inhibitors, ibuprofen, isoniazid, lamotrigine, methotrexate, moclobemide, opioids, organophosphorus insecticides, paracetamol (acetaminophen), paraquat, phenobarbital, phenytoin, quinidine and quinine, salicylates, selective serotonin reuptake inhibitors, sulfonylureas, thallium, theophylline, tricyclic antidepressants, valproic acid, venlafaxine, and warfarin.
- An additional dose of activated charcoal is appropriate for carbamazepine, paracetamol, paraquat, phenobarbital, salicylates, thallium, theophylline, valproic acid, and verapamil to complete gastrointestinal decontamination.
- Activated charcoal can be administered up to 6 hours post-ingestion for many poisons based on individualized risk assessment and beyond 6 hours if ongoing absorption is suspected (e.g., pharmacobezoar formation).
- Multiple-dose activated charcoal for enhanced elimination is appropriate in poisoning with carbamazepine, cardiac glycosides, colchicine, dapsone, phenobarbital, phenytoin, thallium, and theophylline.
- Endotracheal intubation should not be performed solely for activated charcoal administration; it should be considered only if clinically indicated (e.g., airway compromise) or for significant life-threatening toxicity.
- The risk of aspiration after activated charcoal administration post-intubation is low (1-4%), but intubation carries risks such as hypotension, desaturation, and cardiac arrest.
- Nasogastric or orogastric tube insertion without endotracheal intubation should not be performed solely for activated charcoal administration.
- Clinical decisions on activated charcoal use depend on the poison, time since ingestion, symptom severity, and availability of other treatments, despite low-quality evidence.