Poisoning activated charcoal

Cathartics, such as magnesium citrate and sorbitol, were thought to decrease the rate of absorption by increasing gastrointestinal elimination of the poison and the poison-activated charcoal complex, but their value is unproven. Poisoned patients do not routinely require the administration of a cathartic, and it is rarely, if ever, given without concurrent activated charcoal administration. If used, a cathartic should be administered only once and only if bowel sounds are present. Infants, the elderly, and patients with renal failure should be given saline cathartics cautiously, if at all. ... 

Metabolic Effects. Severe metabolic acidosis with high anion gap and hyperglycemia was reported in humans after acute poisoning with endosulfan (Blanco-Coronado et al. 1992 Lo et al. 1995). In five of the six cases reported by Blanco-Coronado et al. (1992), the metabolic acidosis was corrected with gastric lavage with activated charcoal and intravenous sodium bicarbonate and diazepam. No further information regarding metabolic effects in humans after exposure to endosulfan was located. 

Similarly, convulsive seizures and a sustained epileptic state persisted after stomach contents were pumped and activated charcoal and anticonvulsive medication were administered in a 43-year-old man who ingested approximately 260 mg/kg endosulfan (Boereboom et al. 1998). At 4 days after exposure, the man was pronounced brain dead, and autopsy revealed cerebral hernia from massive cerebral edema. Eight additional accidental and/or intentional cases of acute poisoning with endosulfan resulting in adverse neurological effects have been reported in more recent studies, six by Blanco-Coronado et al. (1992), one by Lo et al. (1995), and one by Pradhan et al. (1997) two out of the eight resulted in death. Tonic-clonic convulsions were seen in the Blanco-Coronado et al. (1992) cases, whereas Lo et al. (1995) reported the development of muscle fasciculations and episodes of convulsions in their case. In the case reported by Pradhan et al. (1997), the patient had consumed about 75 mL of hquid endosulfan (35% w/v). In this case, in addition to tonic-clonic seizures and myoclonic jerks, the patient developed... 

Elimination of absorbed substances may be accomplished by administering multiple dose activated charcoal for poisons with entero-hepatic recirculation or by altering urine pH to promote excretion. Forced diuresis, if warranted, should only be done after carefully exercising precautions such as the provision of adequate hydration and maintaining electrolyte balance. 

It is safe to say that washing with tepid water and soap, for external poisons (just cold water for the eye) and activated charcoal are the two simple and effective remedies which have the most universal benefit, according to current knowledge. 

No clinical studies are at hand to study the effect of cathartic, with or without activated charcoal, in reducing the bioavailability of drugs of to improve the outcome of poisoned patients hence the routine use of cathartic with activated charcoal is not recommended in the clinical management of oral poisoning following drug overdoses. 

Urine alkalinization is a treatment modality that increases elimination of poisons by the intravenous administration of sodium bicarbonate to produce urine with a pH of more than or equal to 7.5 and must be supported by high urine flow. This technique might be useful for the elimination of drugs with an acid pKa such as salicylates (but not recommended for phenobarbital intoxication for which multiple-dose activated charcoal is better), chlorpropamide, 2,4-dichlorophenoyacetic acid, diflunisal, fluoride, mecoprop, methotrexate. Complications include severe alkalemia, hypokalemia, hypocalcemia and coronary vasoconstriction. 

American Academy of Clinical Toxicology and European Association of Poisons Centers and Clinical Toxicologists. Position paper single-dose activated charcoal. J Toxicol Clin Toxicol 2005 43(2) 61-87. 

Lall SB, Kumar S, Seth SD. Activated charcoal in acute poisoning current status. Ann Natl Acad Med Sc (India) 1993 29(4) 289-96. 

Spyker DA. Activated charcoal reborn, progress in poison management. Arch Intern Med 1985 145 43-4. 

Activated charcoal adsorbs salicylate effectively, and has been given in repeated oral doses (50 g 4 hourly) to enhance clearance, although its effect on outcome is unknown. Fluid and electrolyte replacement are important and special care should be taken to maintain normal potassium concentrations. Patients with signs of poisoning, especially when plasma salicylate concentration exceeds 500 mg/1, should receive specitic elimination therapy. 

Perform gastric lavage if victim is unconscious or in some instances when conscious Administer activated charcoal to bind poison Administer milk or water if alkali, acid, hydrocarbon, or petroleum distillates have been ingested Administer antidote, if one exists, that is specific for the poison... 

Administer activated charcoal for adsorpfion in emergency management of poisonings as a slurry wifh water, a saline cathartic, or sorbitol... 

The link between colloids and surfaces follows naturally from the fact that particulate matter has a high surface area to mass ratio. The surface area of a 1cm diameter sphere (4jtr ) is 3.14 cm, whereas the surface area of the same amount of material but in the form of 0.1 pm diameter spheres (i.e. the size of the particles in latex paint) is 314 000 cm. The enormous difference in surface area is one of the reasons why the properties of the surface become very important for colloidal solutions. One everyday example is that organic dye molecules or pollutants can be effectively removed from water by adsorption onto particulate activated charcoal because of its high surface area. This process is widely used for water purification and in the oral treatment of poison victims. 

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