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J Med Toxicol. 2010 June; 6(2): 190–198.
Published online 2010 May 20. doi:  10.1007/s13181-010-0046-1
PMCID: PMC2919687

Activated Charcoal for Acute Poisoning: One Toxicologist’s Journey



Keywords: Activated charcoal, Gastrointestinal decontamination, Poisoning, Drug overdose

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Selected References

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1. Rumack BH. Emesis, charcoal and cathartics. JACEP. 1976;44(5):44. [PubMed]
2. Chin L, Picchioni AL, Gillespie T. Saline cathartics and saline cathartics plus activated charcoal as antidotal treatments. Clin Toxicol. 1981;18(7):865–871. doi: 10.3109/15563658108990311. [PubMed] [Cross Ref]
3. Dresibach RH. Handbook of poisoning. 10. Los Altos: Lange Medical Publications; 1980. pp. 24–25.
4. Riegel JM, Becker CE. Use of cathartics in toxic ingestions. Ann Emerg Med. 1981;10:254–258. doi: 10.1016/S0196-0644(81)80051-0. [PubMed] [Cross Ref]
5. Kulig K, Bar-Or DCantrill SV, Rosen P, Rumack BH. Management of acutely poisoned patients without gastric emptying. Ann Emerg Med. 1985;14:562–567. doi: 10.1016/S0196-0644(85)80780-0. [PubMed] [Cross Ref]
6. Albertson TE, Derlet RW, Foulke GE, Minguillon MC, Tharratt SR. Superiority of activated charcoal alone compared with ipecac and activated charcoal in the treatment of acute toxic ingestions. Ann Emerg Med. 1989;18:56–59. doi: 10.1016/S0196-0644(89)80314-2. [PubMed] [Cross Ref]
7. Pond SM, Lewis-Driver DJ, Williams GM, Green AC, Stevenson NW. Gastric emptying in acute overdose: a prospective randomized controlled trial. Med J Austr. 1995;163(7):345–349. [PubMed]
8. Merigian KS, Woodard M, Hedges JR, Roberts JR, Stuebing R, Rashkin MC. Prospective evaluation of gastric emptying in the self-poisoned patient. Am J Emerg Med. 1990;8:479–483. doi: 10.1016/0735-6757(90)90146-Q. [PubMed] [Cross Ref]
9. Pollack MM, Dunbar BS, Holbrook PR, Fields AI. Aspiration of activated charcoal and gastric contents. Ann Emerg Med. 1981;10:528–529. doi: 10.1016/S0196-0644(81)80009-1. [PubMed] [Cross Ref]
10. Justiniani FR, Hippalgaonkar R, Martinez LO. Charcoal-containing empyema complicating treatment for overdose. Chest. 1985;87(3):404–405. doi: 10.1378/chest.87.3.404. [PubMed] [Cross Ref]
11. Menzies DG, Busuttil A, Prescott LF. Fatal pulmonary aspiration of oral activated charcoal. BMJ. 1988;297:459–460. doi: 10.1136/bmj.297.6646.459. [PMC free article] [PubMed] [Cross Ref]
12. Elliott CG, Colby TV, Kelly TM, Hicks HG. Charcoal lung. Bronchiolitis obliterans after aspiration of activated charcoal. Chest. 1989;96:672–674. doi: 10.1378/chest.96.3.672. [PubMed] [Cross Ref]
13. Matthew H, Mackintosh TF, Tompsett SL, Cameron JC. Gastric aspiration and lavage in acute poisoning. BMJ. 1966;1:1333–1337. doi: 10.1136/bmj.1.5499.1333. [PMC free article] [PubMed] [Cross Ref]
14. Harstad E, Moller KO, Simesen MH. U ber den Wert der Magenspu lung bei der Behandlung von akuten Vergiftungen. Acta Med Scand. 1942;112:478–514.
15. Krenzelok EP, McGuigan M, Lheur P. Position statement: ipecac syrup. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol. 1997;35(7):699–709. doi: 10.3109/15563659709162567. [PubMed] [Cross Ref]
16. Chyka PA, Seger D, Krenzelok EP, Vale JA. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. Position paper: single-dose activated charcoal. Clin Toxicol (Phila) 2005;43(2):61–87. [PubMed]
17. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists Position statement and practice guidelines on the use of multi-dose activated charcoal in the treatment of acute poisoning. J Toxicol Clin Toxicol. 1999;37(6):731–751. doi: 10.1081/CLT-100102451. [PubMed] [Cross Ref]
18. Vale JA. Position statement: gastric lavage. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol. 1997;35(7):711–719. doi: 10.3109/15563659709162568. [PubMed] [Cross Ref]
19. Henry JA, Hoffma JR. Continuing controversy on gut decontamination (Commentary) Clin Toxicol. 1998;36(7):753–755. doi: 10.3109/15563659809162631. [Cross Ref]
20. Hoffman RS. Does consensus equal correctness? (Forum) Clin Toxicol. 2000;38(7):689–690. doi: 10.1081/CLT-100102379. [PubMed] [Cross Ref]
21. Bond JR. The role of activated charcoal and gastric emptying in gastrointestinal decontamination: a state of the art review. Ann Emerg Med. 2002;39:273–286. doi: 10.1067/mem.2002.122058. [PubMed] [Cross Ref]
22. Seger D. Single-dose activated charcoal—back up and reassess. Clin Toxicol. 2004;42(1):101–110. doi: 10.1081/CLT-120028754. [PubMed] [Cross Ref]
23. Greene S, Harris C, Singer J. Gastrointestinal decontamination of the poisoned patient. Pediatr Emerg Care. 2008;24(3):176–189. doi: 10.1097/PEC.0b013e318166a092. [PubMed] [Cross Ref]
24. Cooney DO. Activated charcoal in medical applications. New York: Marcel Dekker; 1995.
25. Cooney DO. Activated charcoal in medical applications. New York: Marcel Dekker; 1995. p. 25.
26. Cooney DO. A “superactivated” charcoal for antidotal use in poisonings. Clin Toxicol. 1977;11(4):387–390. doi: 10.3109/15563657708988201. [PubMed] [Cross Ref]
27. Cooney DO. Activated charcoal in medical applications. New York: Marcel Dekker; 1995. p. 29.
28. Cooney DO. Activated charcoal in medical applications. New York: Marcel Dekker; 1995. p. 31.
29. Cooney DO. Activated charcoal in medical applications. New York: Marcel Dekker; 1995. p. 186.
30. Cooney DO. Activated charcoal in medical applications. New York: Marcel Dekker; 1995. p. 214.
31. Chin L, Picchioni AL, Bourn WM, Laird HE. Optimal antidotal dose of activated charcoal. Toxicol Appl Pharmacol. 1973;26:103–108. doi: 10.1016/0041-008X(73)90090-2. [PubMed] [Cross Ref]
32. Jurgens C, Groth Hoegberg LC, Graudal NA. The effect of activated charcoal on drug exposure in healthy volunteers: a meta-analysis. Clin Pharmacol Ther. 2009;85(5):501–505. doi: 10.1038/clpt.2008.278. [PubMed] [Cross Ref]
33. Decker WJ, Combs HF, Corby DG. Adsorption of drugs and poisons by activated charcoal. Toxicol Appl Pharmacol. 1968;13:454–460. doi: 10.1016/0041-008X(68)90122-1. [PubMed] [Cross Ref]
34. Favin FD, Klein-Schwartz W, Oderda GM, Rose SR. In vitro study of lithium carbonate adsorption by activated charcoal. Clin Toxicol. 1988;26(7):443–450. doi: 10.3109/15563658809038560. [PubMed] [Cross Ref]
35. Cooney DO. Activated charcoal in medical applications. New York: Marcel Dekker; 1995. p. 11.
36. Cooney DO. Activated charcoal in medical applications. New York: Marcel Dekker; 1995. p. 440.
37. Cooney DO. Activated charcoal in medical applications. New York: Marcel Dekker; 1995. p. 235.
38. Decker WJ, Corby DG, Hilburn RE, Lynch RE. Adsorption of solvents by activated charcoal, polymers and mineral sorbents. Vet Hum Toxicol. 1981;23(Suppl 1):44–46. [PubMed]
39. Cooney DO. Activated charcoal in medical applications. New York: Marcel Dekker; 1995. pp. 197–294.
40. Curtis RA, Barone J, Giacona N. Efficacy of ipecac and activated charcoal/cathartic. Prevention of salicylate absorption in a simulated overdose. Arch Int Med. 1984;144:48–52. doi: 10.1001/archinte.144.1.48. [PubMed] [Cross Ref]
41. Tenenbein M, Cohen S, Sitar DS. Efficacy of ipecac-induced emesis, orogastric lavage, and activated charcoal for acute overdose. Ann Emerg Med. 1987;16:838–841. doi: 10.1016/S0196-0644(87)80518-8. [PubMed] [Cross Ref]
42. Yeates PJA, Thomas SHL. Effectiveness of delayed activated charcoal administration in simulated paracetamol (acetaminophen) overdose. Br J Clin Pharmacol. 2000;49:11–14. doi: 10.1046/j.1365-2125.2000.00107.x. [PMC free article] [PubMed] [Cross Ref]
43. Green R, Grierson R, Sitar DS, Tenenbein M. How long after drug ingestion is activated charcoal still effective? Clin Toxicol. 2001;39(6):601–605. doi: 10.1081/CLT-100108492. [PubMed] [Cross Ref]
44. Green R, Sitar DS, Tenenbein M. Effect of anticholinergic drugs on the efficacy of activated charcoal. J Toxicol Clin Toxicol. 2004;42(3):267–272. doi: 10.1081/CLT-120037426. [PubMed] [Cross Ref]
45. Mullins M, Froelke BR, Rivera MR. Effect of delayed activated charcoal on acetaminophen concentration after simulated overdose of oxycodone and acetaminophen. Clin Toxicol. 2009;47:112–115. doi: 10.1080/15563650802093681. [PubMed] [Cross Ref]
46. Kirshenbaum LA, Matthews SC, Sitar DS, Tenenbein M. Whole-bowel irrigation versus activated charcoal in sorbitol for the ingestion of modified-release pharmaceuticals. Clin Pharmacol Ther. 1989;46(3):264–271. [PubMed]
47. Laine K, Kivisto KT, Neuvonen PJ. Effect of delayed administration of activated charcoal on the absorption of conventional and slow-release verapamil. Clin Toxicol. 1997;35(3):263–268. doi: 10.3109/15563659709001210. [PubMed] [Cross Ref]
48. Minton NA, Henry JA. Prevention of drug absorption in simulated theophylline overdose. Clin Toxicol. 1995;33(1):43–49. doi: 10.3109/15563659509020214. [PubMed] [Cross Ref]
49. Comstock EG, Boisaubin EV, Comstock BS, Faulkner TP. Assessment of the efficacy of activate charcoal, following gastric lavage in acute drug emergencies. J Toxicol Clin Toxicol. 1982;19(2):149–165. doi: 10.3109/15563658208990377. [PubMed] [Cross Ref]
50. Hulten BA, Adams R, Askenasi R, Dallos V, Dawling S. Activated charcoal in acute tricyclic antidepressant poisoning. Hum Exp Toxicol. 1988;7:307–310. doi: 10.1177/096032718800700402. [PubMed] [Cross Ref]
51. Underhill TJ, Greene MK, Dove AF. A comparison of the efficacy of gastric lavage, ipecacuanha and activated charcoal in the emergency management of paracetamol overdose. Arch Emerg Med. 1990;7:148–154. [PMC free article] [PubMed]
52. Buckley NA, Whyte IM, O’Connell DL, Dawson AH. Activated charcoal reduces the need for N-acetylcysteine treatment after acetaminophen (paracetamol) overdose. Clin Toxicol. 1999;37(6):753–757. doi: 10.1081/CLT-100102452. [PubMed] [Cross Ref]
53. Spiller HA, Winter ML, Klein-Schwartz W, Bangh SA. Efficacy of activated charcoal when administered more than four hours after acetaminophen overdosed. J Emerg Med. 2006;30(1):1–5. doi: 10.1016/j.jemermed.2005.02.019. [PubMed] [Cross Ref]
54. Spiller HA, Sawyer TS. Impact of activated charcoal after acute acetaminophen overdoses treated with N-acetylcysteine. J Emerg Med. 2007;33(2):141–144. doi: 10.1016/j.jemermed.2007.02.016. [PubMed] [Cross Ref]
55. Friberg LE, Isbister GK, Duffull SB. Pharmacokinetic-pharmacodynamic modelling of QT interval prolongation following citalopram overdoses. Br J Clin Pharmacol. 2006;61(2):177–190. doi: 10.1111/j.1365-2125.2005.02546.x. [PMC free article] [PubMed] [Cross Ref]
56. Isbister GK, Friberg LE, Stokes B, Buckley NA, Lee C, Gunja N, Brown SG, Macdonald E, Graudins A, Holdgate A, Duffull SB. Activated charcoal decreases the risk of QT prolongation after citalopram overdose. Ann Emerg Med. 2007;50:593–600. doi: 10.1016/j.annemergmed.2007.03.009. [PubMed] [Cross Ref]
57. Friberg LE, Isbister GK, Hackett LP, Duffill SB. The population pharmacokinetics of citalopram after deliberate self-poisoning: a Bayesian approach. J Pharmacokinet Pharmacodyn. 2005;32:571–605. doi: 10.1007/s10928-005-0022-6. [PubMed] [Cross Ref]
58. Isbister GK, Friberg LE, Hackett LP, Duffill SB. Pharmacokinetics of quetiapine in overdose and the effect of activated charcoal. Clin Pharmacol Ther. 2007;81:821–827. doi: 10.1038/sj.clpt.6100193. [PubMed] [Cross Ref]
59. Kumar VVP, Oscarsson S, Friberg LE, Isbister GK, Hackett LP, Duffill SB. The effect of decontamination procedures on the pharmacokinetics of venlafaxine in overdose. Clin Pharmacol Ther. 2009;86(4):403–410. doi: 10.1038/clpt.2009.114. [PubMed] [Cross Ref]
60. Roberts DM, Southcott E, Potter JM, Roberts MS, Eddleston M, Buckley NA. Pharmacokinetics of digoxin cross-reacting substances in patients with acute yellow oleander (Thevetia peruviana) poisoning, including the effect of activated charcoal. Ther Drug Monit. 2006;28(6):784–792. doi: 10.1097/FTD.0b013e31802bfd69. [PMC free article] [PubMed] [Cross Ref]
61. de Silva HA, Fonseka MMD, Pathmeswaran A, Alahakone DGS, Ratnatilake GA, Gunatilake SB, Ranasinha CD, Lalloo DG, Aronson JK, de Silva HJ. Multiple-dose activated charcoal for treatment of yellow oleander poisoning: a single-blind, randomised, placebo-controlled trial. Lancet. 2003;361:1935–1938. doi: 10.1016/S0140-6736(03)13581-7. [PubMed] [Cross Ref]
62. Eddleston M, Juszczak E, Buckley NA, Senarathna L, Mohamed F, Dissanayake W, Hittarage A, Azher S, Jeganathan K, Jayamanne S, Sheriff MHR, Warrell DA. Mutliple-dose activated charcoal in acute self-poisoning: a randomised controlled trial. Lancet. 2008;371:579–587. doi: 10.1016/S0140-6736(08)60270-6. [PMC free article] [PubMed] [Cross Ref]
63. Merigian KS, Blaho KE. Single-dose oral activated charcoal in the treatment of the self-poisoned patient: a prospective, randomized, controlled trial. Am J Ther. 2002;9:301–308. doi: 10.1097/00045391-200207000-00007. [PubMed] [Cross Ref]
64. Cooper GM, Le Couteur DG, Richardson D, Buckley NA. A randomized clinical trial of activated charcoal for the routine management of oral drug overdose. QJ Med. 2005;98:655–660. [PubMed]
65. Eddleston M, Haggalla S, Reginald K, Sudarshan K, Senthilkumaran M, Karalliedde L, Ariaratnam A, Sheriff MHR, Warrall DA, Buckley NA. The hazards of gastric lavage for intentional self-poisoning in a resource poor location. Clin Toxicol. 2007;45(2):136–143. doi: 10.1080/15563650601006009. [PMC free article] [PubMed] [Cross Ref]
66. Gomez HF, Brent JA, Munoz DC, Mimmack RF, Ritvo J, Phillips S, McKinney P. Charcoal stercolith with intestinal perforation in a patient treated for amitriptyline ingestion. J Emerg Med. 1994;12(1):57–60. doi: 10.1016/0736-4679(94)90013-2. [PubMed] [Cross Ref]
67. Erolgu AH, Kucuktulu U, Erciyes N, Turgutalp H. Multiple dose activated charcoal as a cause of acute appendicitis. J Toxicol Clin Toxicol. 2002;41(1):71–73. [PubMed]
68. Green JP, McCauley W. Bowel perforation after single-dose activated charcoal. Can J Emerg Med. 2006;8(5):358–360. [PubMed]
69. Vilska J. Indications and contraindications of activated charcoal in a poison control center. The viewpoint of the Poison Control Center of Finland. J Toxicol Clin Exp. 1989;9(4):295–298. [PubMed]
70. Spiller HA, Rodgers GC. Evaluation of administration of activated charcoal in the home. Pediatrics. 2001;108(6):E100. doi: 10.1542/peds.108.6.e100. [PubMed] [Cross Ref]
71. Kornberg AE, Dolgin J. Pediatric ingestions: charcoal alone versus ipecac and charcoal. Ann Emerg Med. 1991;20:648–651. doi: 10.1016/S0196-0644(05)82385-6. [PubMed] [Cross Ref]
72. Osterhoudt KC, Alpern ER, Durbin D, Nadel F, Henretig FM. Activated charcoal administration in a pediatric emergency department. Pediatr Emerg Care. 2004;20(8):493–498. doi: 10.1097/01.pec.0000136064.14704.d1. [PubMed] [Cross Ref]
73. Guenther Skokan E, Junkins EP, Corneli HM, Schunk JE. Taste test: children rate flavoring agents used with activated charcoal. Arch Pediatr Adolesc Med. 2001;155:683–686. [PubMed]
74. Dagnone D, Matsui D, Rieder MJ. Assessment of the palatability of vehicles for activated charcoal in pediatric volunteers. Pediatr Emerg Care. 2002;18(1):19–21. doi: 10.1097/00006565-200202000-00006. [PubMed] [Cross Ref]
75. Cheng A, Ratnapalan S. Improving the palatability of activated charcoal in pediatric patients. Pediatr Emerg Care. 2007;23(6):384–386. doi: 10.1097/01.pec.0000278402.45321.f6. [PubMed] [Cross Ref]
76. Boyd R, Hanson J. Prospectuve single blinded randomised controlled trial of two orally administered activated charcoal preparations. J Accid Emerg Med. 1999;16:24–25. [PMC free article] [PubMed]
77. Minocha A, Wiley SH, Chabbra DR, Harper CR, Spyker DA. Superior efficacy of sorbitol cathartics in poisoned patients [abstract] Vet Hum Toxicol. 1986;5:494.
78. Osterhoudt KC, Durbin D, Alpern ER, Henretig FM. Risk factors for emesis after therapeutic use of activated charcoal in acutely poisoned children. Pediatrics. 2004;113:806–810. doi: 10.1542/peds.113.4.806. [PubMed] [Cross Ref]
79. Eizember FL, Tomaszewski CA, Kerns WP. Acupressure for prevention of emesis in patients receiving activated charcoal. J Toxicol Clin Toxicol. 2002;40(6):775–780. doi: 10.1081/CLT-120015838. [PubMed] [Cross Ref]
80. Harris CR, Filandrinos D. Accidental administration of activated charcoal into the lung: aspiration by proxy. Ann Emerg Med. 1993;22:1470–1473. doi: 10.1016/S0196-0644(05)81998-5. [PubMed] [Cross Ref]
81. Sabga E, Dick A, Lertzman M, Tenenbein M. Direct administration of charcoal into the lung and pleural cavity. Ann Emerg Med. 1997;30:695–697. doi: 10.1016/S0196-0644(97)70090-8. [PubMed] [Cross Ref]
82. Graff GR, Stark J, Berkenbosch JW, Holcomb GW, Garola RE. Chronic lung disease after activated charcoal aspiration. Pediatrics. 2002;109:959–961. doi: 10.1542/peds.109.5.959. [PubMed] [Cross Ref]
83. Isbister GK, Downes F, Sibbritt D, Dawson AH, Whyte IM. Aspiration pneumonitis in an overdose population: frequency, predictors, and outcomes. Crit Care Med. 2004;32(1):88–93. doi: 10.1097/01.CCM.0000104207.42729.E4. [PubMed] [Cross Ref]
84. Adnet F, Baud F. Relation between Glasgow Coma Scale and aspiration pneumonia. Lancet. 1996;348(9020):123–124. doi: 10.1016/S0140-6736(05)64630-2. [PubMed] [Cross Ref]
85. Moll K, Kerns W, 2nd, Tomaszewski C, Rose R. Incidence of aspiration pneumonia in intubated patients receiving activated charcoal. J Emerg Med. 1999;17(2):279–283. doi: 10.1016/S0736-4679(98)00192-9. [PubMed] [Cross Ref]
86. Lee AG, Wagner FM, Chen MF, Serrick C, Giaid C, Shennib H. A novel charcoal-induced model of obliterative bronchiolitis-like lesions: implications of chronic nonspecific airway inflammation in the development of posttransplantation obliterative bronchiolitis. J Thorac Cardiovasc Surg. 1998;115(4):822–827. doi: 10.1016/S0022-5223(98)70362-9. [PubMed] [Cross Ref]
87. Arnold TC, Willis BH, Xiao F, Conrad SA, Carden DL. Aspiration of activated charcoal elicits an increase in lung microvascular permeability. Clin Toxicol. 1999;37(1):9–16. doi: 10.1081/CLT-100102402. [PubMed] [Cross Ref]
88. Tomaszewski CA. Activated charcoal—treatment or toxin? (Commentary) Clin Toxicol. 1999;37(1):17–18. doi: 10.1081/CLT-100102403. [PubMed] [Cross Ref]
89. Juurlink DN, McGuigan MA. Gastrointestinal decontamination for enteric-coated aspirin overdose: what to do depends on who you ask. Clin Toxicol. 2000;38(5):465–470. doi: 10.1081/CLT-100102004. [PubMed] [Cross Ref]
90. Bailey B. Gastrointestinal decontamination triangle (letter) Clin Toxicol. 2005;1:59–60. [PubMed]
91. Bailey B. To decontaminate or not to decontaminate? The balance between potential risks and forseeable benefits. Clin Pediatr Emerg Med. 2008;9:17–23. doi: 10.1016/j.cpem.2007.11.001. [Cross Ref]
92. Wiegand TJ, Wu L, Dempsey DA. Algorithm for activated charcoal (AC) use for ingestions [abstract] Clin Toxicol. 2005;43(6):673.

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