When and how to use activated charcoal
Learn when decontamination with activated charcoal will benefit your patients and how to best administer it.
Mar 01, 2013
HOW IT WORKS
TO GIVE OR NOT TO GIVE?
The American Academy of Clinical Toxicology (AACT) and the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) created a position paper in 1997 (revised in 2004) that stated, "Single-dose activated charcoal should not be administered routinely in the management of poisoned patients... [as]... there is no evidence that administration of activated charcoal improves clinical outcome."1 Since then, the use of activated charcoal in human medicine has declined from 7.7% in 1995 to 5.9% in 2003, according to the American Association of Poison Control Centers Toxic Exposure Surveillance System.1 Despite the move in human medicine away from activated charcoal administration,1 the question of whether to continue to administer activated charcoal as part of the detoxification of poisoned patients still exists in veterinary medicine.2
Table 1 presents the results of 122 comparison studies in people that evaluated 46 drugs (e.g. acetaminophen, amiodarone, carbamazepine, fluoxetine, phenylbutazone, phenytoin, theopylline, verapamil), the absolute amount of charcoal administered (0.5 to 100 g), and the time of administration (up to 360 minutes after ingestion).1 Unfortunately, in these studies, certain factors could not be controlled, such as the influence of food in the stomach or the presence of a toxicant that may delay gastric emptying.1
Limited veterinary literature exists. Most of the animal studies were performed in mice and rats, not in dogs and cats. It is important to consider the differences in the patients' comparative anatomy, metabolism, GI motility, and morphology, as well as the toxicant's absorption rate and site, and route of elimination.1 A recent prospective study evaluated the effect of activated charcoal administration alone vs. emesis and activated charcoal administration in dogs after an experimental overdose of carprofen and found that activated charcoal administration alone was as effective as the combination was.4