NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 5403

POLICIES AND PROCEDURES

Subject: Medical Direction

Activated Charcoal Protocol

Associated Policies: 02/07/98

  1. Class:
  1. Absorbent
  1. Indications:
  1. Acute management of many oral poisonings.
  1. Therapeutic Effects:
  1. Binds with drugs and chemicals within GI tract and decreases intestinal absorption in the overdose situation thereby preventing toxicity.
  2. The poison and charcoal compound is then excreted from the body.
  1. Contraindications:
  1. Absolute:
  1. Do not use Activated Charcoal with Sorbitol in pediatrics < 35 kg.
  2. Do not use concentrations of Activated Charcoal with Sorbitol greater than 208mg/ ml in pediatrics < 12 years.
  1. Relative:
  1. Decreasing level of consciousness unless intubated prior to administration.
  2. Ingestion or poisonings due to:
  1. Cyanide.
  2. Corrosives.
  3. Petroleum distillates.
  1. Adverse Effects:
  1. Vomiting.
  2. Constipation.
  3. Black stools.
  1. Administration and Dosage:
  1. Adult:
  1. 50 Gm of Activated Charcoal premixed with Sorbitol and water to form a slurry to facilitate delivery. Administer via PO, OG, or NG routes.
  1. Pediatric:
  1. > 35 kg: 1 Gm/ kg of Activated Charcoal premixed with Sorbitol and water to form a slurry to facilitate delivery. Administer via PO, OG, or NG routes.
  2. < 35 kg: 1 Gm/ kg of Activated Charcoal premixed with water to form a slurry to facilitate delivery. Administer via PO, OG, or NG routes.
  1. Special Information:
  1. Administer after completion of vomiting in cases where syrup of ipecac has been administrated.
  2. Other medications, including ipecac, will be absorbed by charcoal.
  3. Shake container vigorously for a minimum of 30 seconds.
  4. Charcoal binds with the "volume" of toxic ingested. Even small amounts of charcoal successfully administered may be helpful to prevent a lethal ingestion. If quantity of ingestion is known, may consider formula of 10 times the ingested dose of toxin by weight for pediatric patients.
  5. Will not bind with alcohol, heavy metal (e.g. iron, lead) or lithium.
  6. If gastric lavage is being used to facilitate stomach evacuation, a single dose of activated charcoal can be administered in the early stages of gastric lavage with Base order. If this technique is used, Activated Charcoal without Sorbitol should be used.