Charcoal, Activated

Definition

Activated charcoal is a fine black odorless and tasteless powder made from wood or other materials that have been exposed to very high temperatures in an airless environment. It is then treated, or activated, to increase its ability to adsorb various substances by reheating with oxidizing gas or other chemicals to break it into a very fine powder. Activated charcoal is pure carbon specially processed to make it highly adsorbent of particles and gases in the body's digestive system.

Activated charcoal has often been used since ancient times to cure a variety of ailments including poisoning. Its healing effects have been well documented since as early as 1550 B.C. by the Egyptians. However, charcoal was almost forgotten until 15 years ago when it was rediscovered as a wonderful oral agent to treat most overdoses and toxins.

Description

Activated charcoal's most important use is for treatment of poisoning. It helps prevent the absorption of most poisons or drugs by the stomach and intestines. In addition to being used for most swallowed poisons in humans, charcoal has been effectively used in dogs, rabbits, rats, and other animals, as well. It can also adsorb gas in the bowels and has been used for the treatment of gas or diarrhea. Charcoal's other uses such as treatment of viruses, bacteria, bacterial toxic byproducts, snake venoms and other substances by adsorption have not been supported by clinical studies. By adding water to the powder to make a paste, activated charcoal can be used as an external application to alleviate pain and itching from bites and stings.

Poisons and drug overdoses

It is estimated that one million children accidentally overdose on drugs mistaken as candies or eat, drink, or inhale poisonous household products each year. Infants and toddlers are at the greatest risk for accidental poisoning. Activated charcoal is one of the agents most commonly used for these cases. It can absorb large amounts of poisons quickly. In addition, it is non-toxic, may be stored for a long time, and can be conveniently administered at home. Charcoal works by binding to irritating or toxic substances in the stomach and intestines. This prevents the toxic drug or chemical from spreading throughout the body. The activated charcoal with the toxic substance bound to it is then excreted in the stool without harm to the body. When poisoning is suspected the local poison control center should be contacted for instructions. They may recommend using activated charcoal, which should be available at home so that it can be given to the poisoned child or pet immediately. For severe poisoning, several doses of activated charcoal may be needed.

Activated charcoal is also used to induce vomiting in adults who have attempted suicide by taking an overdose of antidepressants, barbiturates, or benzodiazepine tranquilizers.

Intestinal disorders

In the past, activated charcoal was a popular remedy for flatus (intestinal gas). Even before the discovery of America by Europeans, Native Americans used powdered charcoal mixed with water to treat an upset stomach. Although charcoal has been recommended as an alternative treatment for flatus, however, studies done in the early 2000s have reported that it is not particularly useful in treating intestinal gas. Such other measures as dietary changes or biofeedback training are more effective in relieving patients' symptoms.

Charcoal has also been used to treat such other intestinal disorders as diarrhea, constipation, and cramps. There are few studies to support these uses and there are also concerns that frequent use of charcoal may decrease absorption of essential nutrients, especially in children.

Other uses

Besides being a general antidote for poisons or remedy for gas, activated charcoal has been used to treat other conditions as well. Based on its ability to adsorb or bind to other substances, charcoal has been effectively used to clean skin wounds and to adsorb waste materials from the gastrointestinal tract. In addition, it has been used to adsorb snake venoms, viruses, bacteria, and harmful materials excreted by bacteria or fungi. However, because of lack of scientific studies, these uses are not recommended. Activated charcoal, when used together with other remedies such as aloe vera, acidophilus, and psyllium, helps to keep symptoms of ulcerative colitis under control. While charcoal shows some anti-aging activity in rats, it is doubtful if it has the same effect in humans.

Apart from its medicinal applications, activated charcoal is used by biologists to cool cell suspensions; by public health physicians to filter disease organisms from drinking water; and by environmental scientists to remove organic pollutants from ocean sediments.

Recommended dosage

For poisoning

Activated charcoal is available without prescription. In cases of accidental poisoning or drug overdose, however, one should call an emergency poison control center, hospital emergency room, or doctor's office for advice. In case that both syrup of ipecac and charcoal are recommended for treatment of the poison, ipecac should be given first. Charcoal should not be given for at least 30 minutes after ipecac or until vomiting from ipecac stops. Activated charcoal is often mixed with a liquid before being swallowed or put into the tube leading to the stomach. Activated charcoal is available as 1.1 oz (33 m) liquid bottles. It is also available in 0.5 oz (15 ml) container sizes and as slurry of charcoal pre-mixed in water or as a container to which water or soda pop can be added. Keeping activated charcoal at home is a good idea so that it can be taken immediately when needed for treatment of poisoning.

For acute poisoning, the dosage is as follows:

• Infants (under 1 year of age): 1 g/kg.
• Children (1-12 years of age): 15-30 g or 1-2 g/kg with at least 8 oz of water.
• Adults: 30-100 g or 1-2 g/kg with at least 8 oz of water.

For diarrhea or gas

A person can take charcoal tablets or capsules with water or sprinkle the content onto foods. The dosage for treatment of gas or diarrhea in adults is 520-975 mg after each meal and up to 5 g per day.

Precautions

Parents should keep activated charcoal on hand in case of emergencies.

Charcoal should not be given together with syrup of ipecac. The charcoal will adsorb the ipecac. Charcoal should be taken 30 minutes after ipecac or after the vomiting from ipecac stops.

Some activated charcoal products contain sorbitol. Sorbitol is a sweetener as well as a laxative, therefore, it may cause severe diarrhea and vomiting. These products should not be used in infants.

Charcoal may interfere with the absorption of medications and nutrients such as vitamins or minerals. For uses other than for treatment of poisoning, charcoal should be taken two hours after other medications.

Charcoal should not be used to treat poisoning caused by such corrosive products as lye or other strong acids or petroleum products such as gasoline, kerosene, or cleaning fluids. Charcoal may make the condition worse and delay diagnosis and treatment. In addition, charcoal is also not effective if the poison is lithium, cyanide, iron, ethanol, or methanol.

Parents should not mix charcoal with chocolate syrup, sherbet, or ice cream, even though it may make charcoal taste better. These foods may prevent charcoal from working properly.

Activated charcoal may cause swelling or pain in the stomach. A doctor should be notified immediately. It has been known to cause problems in people with intestinal bleeding, blockage or those people who have had recent surgery. These patients should talk to their doctor before using this product.

Charcoal may be less effective in people with slow digestion.

Charcoal should not be given for more than three or four days for treatment of diarrhea. Continuing for longer periods may interfere with normal nutrition.

Charcoal should not be used in children under three years of age to treat diarrhea or gas.

Activated charcoal should be kept out of reach of children.

Side effects

Charcoal may cause constipation when taken for a drug overdose or accidental poisoning. A laxative should be taken after the crisis is over.

Activated charcoal may cause the stool to turn black. This side effect is to be expected.

Patients should consult a doctor if they have pain or swelling of the stomach.

Interactions

Activated charcoal should not be mixed with chocolate syrup, ice cream, or sherbet to make it more palatable. These foods prevent the charcoal from working properly.

KEY TERMS

Antidote— A remedy to counteract a poison or injury.

Adsorption— The binding of a chemical (e.g., drug or poison) to a solid material such as activated charcoal or clay.

Flatus— Gas or air in the digestive tract.

Resources

BOOKS

Beers, Mark H., MD, and Robert Berkow, MD, editors. "Poisoning." Section 23, Chapter 307. In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Beers, Mark H., MD, and Robert Berkow, MD, editors. "Psychiatric Emergencies." Section 15, Chapter 194. In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2002.

Cooney, David. Activated Charcoal: Antidote, Remedy, and Health Aid. Brushton, NY: TEACH Services, Inc., 1999.

Wilson, Billie A., Margaret T. Shannon, and Carolyn L. Stang. "Charcoal, Activated (Liquid Antidote)." Nurses Drug Guide 2000. Stamford, CT: Appleton & Lange, 2000.

PERIODICALS

Azpiroz, F., and J. Serra. "Treatment of Excessive Intestinal Gas." Current Treatment Options in Gastroenterology 7 (August 2004): 299-305.

Ho, K. T., R. M. Burgess, M. C. Pelletier, et al. "Use of Powdered Coconut Charcoal as a Toxicity Identification and Evaluation Manipulation for Organic Toxicants in Marine Sediments." Environmental Toxicology and Chemistry 23 (September 2004): 2124-2131.

Littlejohn, C. "Management of Intentional Overdose in A & E Departments." Nursing Times 100 (August 17, 2004): 38-43.

Matsui, T., J. Kajima, and T. Fujino. "Removal Effect of the Water Purifier for Home Use Against Cryptosporidium parvum Oocysts." Journal of Veterinary Medical Science 66 (August 2004): 941-943.

Morris, G. J., and H. E. Richens. "Improved Methods for Controlled Rapid Cooling of Cell Suspensions." Cryo Letters 25 (July-August 2004): 265-272.

Osterhoudt, K. C., E. R. Alpern, D. Durbin, et al. "Activated Charcoal Administration in a Pediatric Emergency Department." Pediatric Emergency Care 20 (August 2004): 493-498.

ORGANIZATIONS

American Society of Health-System Pharmacists (ASHP). 7272 Wisconsin Avenue, Bethesda, MD 20814. (301) 657-3000. 〈http://www.ashp.org〉.

United States Food and Drug Administration (FDA). 5600 Fishers Lane, Rockville, MD 20857-0001. (888) INFOFDA. 〈http://www.fda.gov〉.

Charcoal, Activated

Definition

Activated charcoal is pure carbon. It is a fine, black, odorless, and tasteless powder made from wood or other materials that have been exposed to very high temperatures in an airless environment. This material is then treated, or activated, to increase its ability to adsorb various substances by reheating with oxidizing gas or other chemicals to break it into a very fine powder that is highly adsorbent of particles and gases in the body's digestive system.

Purpose

Activated charcoal has been used since ancient times to cure a variety of ailments including poisoning. Its healing effects have been well documented since as early as 1550 b.c. by the Egyptians. In modern times activated charcoal is used as an oral agent to treat overdoses and toxins.

Poisons and drug overdoses

Infants and toddlers are at the greatest risk for accidental poisoning. Activated charcoal is one of the agents most commonly used to treat these cases. It can adsorb large amounts of poisons quickly. In addition, it is non-toxic, may be stored for a long time, and can in an emergency be administered at home by individuals without medical training. Charcoal works by binding to irritating or toxic substances in the stomach and intestines. This prevents the toxic drug or chemical from spreading throughout the body. The activated charcoal with the toxic substance bound to it is then excreted in the stool without harm to the body. When poisoning is suspected, a local poison control center or emergency center should be contacted for instructions. They may recommend using activated charcoal, which should be available at home so that it can be given to the poisoned child or pet immediately. For severe poisoning, several doses of activated charcoal as well as other medical interventions may be needed.

Activated charcoal is also used to induce vomiting in adults who have attempted suicide by taking an overdose of antidepressants, barbiturates, or benzodiazepine tranquilizers.

Intestinal disorders

In the past, activated charcoal was a popular remedy for flatus (intestinal gas). Even before the discovery of America by Europeans, Native Americans used powdered charcoal mixed with water to treat upset stomach. Although activated charcoal has been recommended as an alternative treatment for flatus, studies done in the early 2000s have reported that it is not particularly effective. Other measures such as dietary changes or biofeedback training are more effective in relieving patients' symptoms.

Activated charcoal has also been used to treat intestinal disorders such as diarrhea, constipation, and cramps. There are few studies to support these uses, and there are concerns that frequent use of charcoal may decrease absorption of essential nutrients, especially in children.

Alternative uses

Based on its ability to bind other substances, activated charcoal has been effectively used to clean skin wounds and to adsorb waste materials from the gastrointestinal tract. In addition, it has been used to adsorb snake venoms, viruses, bacteria, and harmful materials excreted by bacteria or fungi. However, because of lack of controlled scientific studies, these uses are not recommended in traditional medicine. Activated charcoal, when used with other remedies such as aloe vera, acidophilus, and psyllium, can help to keep symptoms of ulcerative colitis under control. While activated charcoal shows some anti-aging activity in rats, it is doubtful that it has the same effect in humans.

Apart from its medicinal applications, activated charcoal is used by biologists to cool cell suspensions; by public health physicians to filter disease organisms from drinking water; and by environmental scientists to remove organic pollutants from ocean sediments.

Precautions

Families should keep activated charcoal on hand in case of emergencies. Activated charcoal should be given at home under direction of a poison center physician or nurse.

Activated charcoal should not be given together with syrup of ipecac, another common treatment for posionings. The charcoal will adsorb the ipecac and inactivate it. Activated charcoal should be taken only after induced vomiting stops.

Some activated charcoal products contain sorbitol. Sorbitol is a sweetener as well as a laxative, therefore, it may cause diarrhea and vomiting. It should not be used in infants.

Activated charcoal may interfere with the absorption of medications and nutrients such as vitamins or minerals. For uses other than for treatment of poisoning, activated charcoal should only be taken two hours after other medications.

Activated charcoal should not be used to treat poisoning caused by such corrosive products such lye, strong acids, or petroleum products such as gasoline, kerosene, or cleaning fluids. It may make the condition worse and delay diagnosis and treatment. In addition, activated charcoal is also not effective against the poisons lithium, cyanide, iron, ethanol, or methanol.

Parents should not mix activated charcoal with chocolate syrup, sherbet, or ice cream, even though it may make the taste better. These foods may prevent it from working properly.

Activated charcoal may cause swelling or pain in the stomach. In these cases, a doctor should be notified immediately. It has been known to cause problems in people with intestinal bleeding, blockage, or those people who have had recent surgery. These patients should talk to their doctor before using this product. Activated charcoal may also be less effective in people with slow digestion.

Activated charcoal should not be used in children under three years of age to treat diarrhea or gas and should not be used for more than three or four days for treatment of diarrhea in adults. Continuing for longer periods may interfere with normal nutrition. As with all medications, activated charcoal should be kept out of reach of children.

Description

Activated charcoal's most important use is for treatment of poisoning. It helps prevent the absorption of most poisons or drugs by the stomach and intestines. In addition to being used for most swallowed poisons in humans, activated charcoal has been effectively used in dogs, rabbits, rats, and other animals.

For poisoning

Activated charcoal is available without prescription. It is available as 1.1 oz (33 m) liquid bottles. It is also available in 0.5 oz (15 ml) container sizes and as slurry of charcoal pre-mixed in water or as a container to which water or a carbonated beverage can be added. Keeping activated charcoal at home is often recommended so that it can be taken immediately when needed for treatment of poisoning.

In cases of accidental poisoning or drug overdose, one should call an emergency poison control center, hospital emergency room, or doctor's office for advice on administering activated charcoal. If both syrup of ipecac and charcoal are recommended for treatment of the poison, ipecac, which induces vomiting, should be given first. Activated charcoal should not be given for at least 30 minutes after ipecac or until induced vomiting stops. Activated charcoal is often mixed with a liquid before being swallowed or put into the tube leading to the stomach when given in an emergency room.

For diarrhea or gas

A person can take charcoal tablets or capsules with water or sprinkle the content onto foods.

Preparation

No preparation is required before administering activated charcoal. If it is to be taken in addition to ipecac syrup, ipecac should be taken first. The activated charcoal should not be administered until the vomiting has stopped, generally at least 30 minutes.

Aftercare

Charcoal may cause constipation when taken for a drug overdose or accidental poisoning. A laxative may be taken after the crisis is over. Additional aftercare may be required depending on type and extent of the poisoning.

Complications

Activated charcoal may cause the stool to turn black. This side effect is to be expected.

Results

In cases where the degree of poisoning is not too severe, activated charcoal is expected to effectively relieve the symptoms of poisoning by substances such as antidepressants, barbiturates, or benzodiazepine tranquilizers. It is not expected to be effective in cases of poisoning by substances such as lithium, cyanide, iron, ethanol, or methanol.

Health care team roles

Many different health care team members may administer activated charcoal. These include emergency medical technicians, emergency room personnel, nurses, and other healthcare staff. Poison control center workers, advice nurses, and other health care team members may advise a parent or other caretaker to administer activated charcoal in the case of accidental poisoning if the patient is at home and activated charcoal is available.

KEY TERMS

Antidote— A remedy to counteract a poison or injury.

Adsorption— The binding of a chemical (e.g., drug or poison) to a solid material such as activated charcoal or clay.

Flatus— Gas or air in the digestive tract.

Resources

BOOKS

Bansal, Roop Chand, and Meenakshi Goyal. Activated Carbon Adsorption. Boca Raton, FL: Taylor and Francis, 2005.

Harris, Carson R., ed. The Toxicology Handbook for Clinicians. Philadelphia: Hanley and Belfus, 2006.

Linden, Christopher H., James M. Rippe, and Richard S. Irwin, eds. Manual of Overdoses and Poisonings. Philadelphia: Lippincott Williams and Wilkins, 2005.

PERIODICALS

Alaspaa, Ari O., Markku J. Kuisma, Hoppu Kalle, and Pertti J. Neuvonen. "Out of Hospital Administration of Activated Charcoal by Emergency Medical Services." Annals of Emergency Medicine 45 (February 2005): 207-213.

Osterhoudt, Kevin C., Dennis Durbin, Elizabeth R. Alpern, and Fred M. Henretig. "Risk Factors for Emesis after Therapeutic Use of Activated Charcoal in Acutely Poisoned Children." Pediatrics 113 (April 2004): 806-811.

Seger. Donna. "Single-Dose Activated Charcoal-Backup and Reassess." Journal of Toxicology: Clinical Toxicology 42 (January 2004): 101-111.

Charcoal, activated

Description

Activated charcoal is a fine, black, odorless, and tasteless powder. It is made from wood or other materials that have been exposed to very high temperatures in an airless environment. It is then treated, or activated, to increase its ability to adsorb by reheating with oxidizing gas or other chemicals to break into a very fine powder. Activated charcoal is pure carbon specially processed to make it highly adsorbent of particles and gases in the body's digestive system.

Activated charcoal has often been used since ancient times to cure a variety of ailments including poisoning. Its healing effects have been well documented since as early as 1550 b.c. by the Egyptians. However, charcoal was almost forgotten until 15 years ago when it was rediscovered as a wonderful oral agent to treat most overdoses and toxins.

General use

Activated charcoal's most important use is for treatment of poisoning. It helps prevent the absorption of most poisons or drugs by the stomach and intestines. In addition to being used for most swallowed poisons in humans, charcoal has been effectively used in dogs, rabbits, rats and other animals, as well. It can also absorb gas in the bowels and has been used for the treatment of gas or diarrhea . Charcoal's other uses such as treatment of viruses, bacteria, bacterial toxic byproducts, snake venoms and other substances by adsorption have not been supported by clinical studies. By adding water to the powder to make a paste, activated charcoal can be used as an external application to alleviate pain and itching from bites and stings .

Poisons and drug overdoses

It is estimated that one million children accidentally overdose on drugs mistaken as candies or eat, drink, or inhale poisonous household products each year. In the year 2000, the American Association of Poison Control Centers said that more than 1,142,000 calls had been received in centers around the country about poison exposures to children under six years of age. Activated charcoal is one of the agents most commonly used for infants and toddlers. It can absorb large amounts of poisons quickly. In addition, it is non-toxic, may be stored for a long time, and can be conveniently administered at home. Charcoal works by binding to irritating or toxic substances in the stomach and intestines. This prevents the toxic drug or chemical from spreading throughout the body. The activated charcoal with the toxic substance bound to it is then excreted in the stool without harm to the body.

When poisoning is suspected the local poison control center should be contacted for instructions. They may recommend using activated charcoal, which should be available at home so that it can be given to the poisoned child or pet immediately. For severe poisoning, several doses of activated charcoal may be needed. A 2002 study showed that in some cases, charcoal could be administered at home sooner than in the emergency room, and was beneficial for children who had ingested poisonous mushrooms. However, the study concluded that more research was needed to be sure that home-administered doses were accurate and the best solution for other types of poisoning.

Intestinal disorders

In the past, activated charcoal was a popular remedy for gas. Even before the discovery of America by Europeans, Native Americans used powdered charcoal mixed with water to treat an upset stomach. Now charcoal is being rediscovered as an alternative treatment for this condition. Activated charcoal works like a sponge. Its huge surface area is ideal for soaking up different substances, including gas. In one study, people taking activated charcoal after eating a meal with high gas-producing foods did not produce more gas than those who did not have these foods. Charcoal has also been used to treat other intestinal disorders such as diarrhea, constipation , and cramps. There are few studies to support these uses and there are also concerns that frequent use of charcoal may decrease absorption of essential nutrients, especially in children.

Other uses

Besides being a general antidote for poisons or remedy for gas, activated charcoal has been used to treat other conditions as well. Based on its ability to adsorb or bind to other substances, charcoal has been effectively used to clean skin wounds and to adsorb waste materials from the gastrointestinal tract. In addition, it has been used to adsorb snake venoms, viruses, bacteria, and harmful materials excreted by bacteria or fungi. However, because of lack of scientific studies, these uses are not recommended. Activated charcoal, when used together with other remedies such as aloe vera, acidophilus , and psyllium , helps to keep symptoms of ulcerative colitis under control. While charcoal shows some anti-aging activity in rats, it is doubtful if it can do the same for humans.

Preparations

For poisoning

Activated charcoal is available without prescription. However, in case of accidental poisoning or drug overdose an emergency poison control center, hospital emergency room, or doctor's office should be called for advice. In cases where both syrup of ipecac and charcoal are recommended for treatment of the poison, ipecac should be given first. Charcoal should not be given for at least 30 minutes after ipecac or until vomiting from ipecac stops. Activated charcoal is often mixed with a liquid before being swallowed or put into the tube leading to the stomach. Activated charcoal is available as 30-gram liquid bottles. It is also available in 15-gram container sizes and as slurry of charcoal pre-mixed in water or as a container in which water or soda pop is added. Keeping activated charcoal at home is a good idea so that it can be taken immediately when needed for treatment of poisoning.

For acute poisoning, the dosage is as follows:

• infants (under 1 year of age): 1 g/kg
• children (1-12 years of age): 15-30 g or 1-2 g/kg with at least 8 oz of water
• adults: 30-100 g or 1-2 g/kg with at least 8 oz of water

For diarrhea or gas

A person can take charcoal tablets or capsules with water or sprinkle the content onto foods. The dosage for treatment of gas or diarrhea in adults is 520-975 mg after each meal and up to 5 g per day.

Precautions

Parents should keep activated charcoal on hand in case of emergencies.

Charcoal should not be taken together with syrup of ipecac, as the charcoal will adsorb the ipecac. Charcoal should be taken 30 minutes after ipecac or after the vomiting from ipecac stops.

Some activated charcoal products contain sorbitol. Sorbitol is a sweetener as well as a laxative, therefore, it may cause severe diarrhea and vomiting. These products should not be used in infants.

Charcoal may interfere with the absorption of medications and nutrients such as vitamins or minerals. For uses other than for treatment of poisoning, charcoal should be taken two hours after other medications.

Charcoal should not be used to treat poisoning caused by corrosive products such as lye or other strong acids or petroleum products such as gasoline, kerosene, or cleaning fluids. Charcoal may make the condition worse and delay diagnosis and treatment. In addition, charcoal is also not effective if the poison is lithium, cyanide, iron , ethanol, or methanol.

Parents should not mix charcoal with chocolate syrup, sherbet, or ice cream, even though it may make charcoal taste better. These foods may prevent charcoal from working properly.

Activated charcoal may cause swelling or pain in the stomach. A doctor should be notified immediately. It has been known to cause problems in people with intestinal bleeding, blockage or those people who have had recent surgery. These patients should talk to their doctor before using this product.

Charcoal may be less effective in people with slow digestion.

Charcoal should not be given for more than three or four days for treatment of diarrhea. Continuing for longer periods may interfere with normal nutrition .

Charcoal should not be used in children under three years of age to treat diarrhea or gas.

Activated charcoal should be kept out of reach of children.

Side effects

Charcoal may cause constipation when taken for overdose or accidental poisoning. A laxative should be taken after the crisis is over.

Activated charcoal may cause the stool to turn black. This is to be expected.

Pain or swelling of the stomach may occur. A doctor should be consulted.

Interactions

Activated charcoal should not be mixed together with chocolate syrup, ice cream or sherbet. These foods prevent charcoal from working properly.

Resources

BOOKS

Blumenthal, Mark. Linden Charcoal. The Complete German Commission E Monographs, Therapeutic Guide to Herbal Medicines, American Botanical Council, Boston: Integrative Medicine Communications, 1998. Accessed online. http://home.mdconsult.com.

Cooney, David. Activated Charcoal: Antidote, Remedy, and Health Aid. Brushton, NY: TEACH Services, Inc., 1999.

Lacy Charles F., Lora L. Amstrong, Naomi B. Ingrim, and Leonard L. Lance. Charcoal. The Drug Information Handbook Pocket Version: 1998-1999, Hudson, OH: Lexi-Comp Inc., 1998.

Roberts. Activated Charcoal. Clinical Procedures in Emergency Medicine, Philadelphia, PA: W. B. Saunders Company, 1998: 726-8. Accessed online. http://home.mdconsult.com.

Wilson, Billie A., Margaret T. Shannon, and Carolyn L. Stang. Charcoal, Activated (Liquid Antidote). Nurses Drug Guide 2000, Stamford, CT: Appleton & Lange, 2000.

PERIODICALS

Bond, C. Randall. "Activated Charcoal in the Home: Helpful and Important or Simply a Distraction." Pediatrics (January 2002) : 145.

Mai Tran

Teresa G. Odle