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.