Ver el código de «Activated charcoal»

==General==
[[File:ActivatedCharcoalPowder BrightField.jpg|thumb|A micrograph of activated charcoal showing fractal-like shape of the particles that provides an enormous surface area. Each particle in this image, despite being only around 0.1 mm across, can have a surface area of several square centimeters.]]
*Type: [[Antidote]]
*A fine, black, odorless powder recognized for more than 2 centuries as an effective adsorbent of many substances
*Common Trade Names: Actidose-Aqua [OTC]; Actidose/Sorbitol [OTC]; Char-Flo with Sorbitol [OTC]; EZ Char [OTC]; Kerr Insta-Char in Sorbitol [OTC]; Kerr Insta-Char [OTC] <ref>Activated Charcoal. online.lexi.com.elibrary.einstein.yu.edu/lco/action/doc/retrieve/docid/patch_f/6579?hl=5864#f_pregnancy-and-lactation. Updated 10/5/15. Accessed 12/30/15. </ref>

==Adult Dosing==
*25-100gm PO<ref name="AACT PP" />
*Common standard dose is 50gm
*10:1 ratio of charcoal to xenobiotic typically recommended
*If not pre-mixed best administered in a 1:8 ratio of AC to liquid (water, coke)
*AC alone comparably effective to AC to cathartic (sorbitol, Mg citrate)
**if cathartic is used, it should only be a single time (avoid in [[multidose activated charcoal]] therapy)
**repeated dosages associated with dehydration, hypotension, electrolyte derangements

==Pediatric Dosing==
*0.5-1 gm/kg PO<ref name="AACT PP" />

==Special Populations==
*[[Drug pregnancy categories‎‎|Pregnancy Rating]]: not absorbed
*[[Pregnancy and lactation drug labeling|Lactation risk]]: not absorbed 
*Renal Dosing 
**Adult 
**Pediatric 
*Hepatic Dosing 
**Adult 
**Pediatric

==Indications==
*Should be considered for a poisoned or overdosed patient after risk-to-benefit assessment of the ingested substance and patient-specific factors
*Ingested drug is adsorbed by charcoal AND one of the following: 
**Time since ingestion is less than 1-2hr 
**Drug has significant enterohepatic circulation 
**Drug delays gastric emptying AND time since ingestion is <4hr 
**Drug is a controlled release preparation AND time since ingestion is <12-18hr

THE KILLER CS
*Cyanide
*Colchicine
*Calcium channel blockers
*Cyclic antidepressants
*Cardioglycosides
*Cyclopeptide mushrooms (''Amanita phalloides'')
*Cocaine
*Cicutoxin (water hemlock)
*Salicylates

===AACT recommendations===
*Activated charcoal "should not be administered routinely in the management of poisoned patients."<ref name="AACT PP">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.</ref>
*Consider if patient presents within one hour of an ingestion of a toxic amount of a substance known to be absorbed by charcoal
**Administration of charcoal after an hour may continue to be beneficial
*They emphasize that there is no definitive data that activated charcoal improves clinical outcome

==Contraindications==
*[[Altered mental status]]
*Intestinal [[SBO|obstruction]]
*Increased risk of aspiration
*Ingestion of substances not absorbed by charcoal
*Instances where urgent endoscopy will be needed (eg. Ingestion of caustic material)

===Limitations===
*Does not work with:
**Heavy metals ([[Iron Toxicity|Iron]], [[Lead Toxicity|Lead]], [[Arsenic]], [[Mercury]], Zinc)
**Inorganic ions ([[Lithium]], Potassium, Sodium, Fluoride and Iodine)
**[[Hydrocarbons]]/essential oils
**Toxic alcohols ([[Ethylene Glycol Toxicity|Ethylene Glycol]], [[Methanol Toxicity|Methanol]], [[Isopropyl Alcohol Toxicity|Isopropanol]])
**Acids/bases
**[[Organophosphates]]

==Adverse Reactions==
*[[Aspiration Pneumonia and Pneumonitis|Aspiration]]
*[[Small Bowel Obstruction (SBO)|Bowel obstruction]]

==Pharmacology==
*Half-life: not absorbed
*Metabolism: not absorbed
*Excretion: excreted whole in feces 
*Adsorption begins within about 1 minute but may not achieve equilibrium for 10-25 minutes
*Clinical efficacy inversely related to time elapsed after ingestion and depends on rate of adsorption of xenobiotic

===Mechanism of action===
*Large surface area of the charcoal binds toxins and prevents their absorption
*Interrupts enteroenteric/enterohepatic circulation of drugs<ref name="Multi">Position statement and practice guidelines on the use of multi-dose activated charcoal in the treatment of acute poisoning. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol. 1999;37(6):731-51.</ref>

==Comments==
*Created by heating wood and other natural materials in an airless environment
*"Activated" by turning into fine powder, which ↑ surface area

==See Also==
*[[Gastric Lavage]] 
*[[Multidose Activated Charcoal (MDAC)]]

==References==
<references/>

[[Category:Pharmacology]]
[[Category:Procedures]] 
[[Category:Toxicology]]
[[Category:EMS]]