Activated Charcoal Part II: This is How We Treat the Poisoned

In our last post, I discussed activated charcoal and some of its benefits.  Take a look at the previous post titled, “Activated Charcoal Part I: What’s the Big Deal?” by clicking here.  It’s a quick read.  A swashbuckling adventure.  Just kidding - but I do encourage you to review it at your leisure. This one gets a bit heavier.

This week I dug a little deeper into David O. Cooney’s book titled, “Activated Charcoal in Medical Applications” (2009).  In it, Cooney discusses how, through oral administration, activated charcoal reduces the systematic absorption of many kinds of drugs and chemicals, including analgesics (pain relievers); antipyretics (fever reducers); sedatives and hypnotics (benzodiazepines such as Xanax or Valium); alkaloids (like morphine, codine, quinine); tricyclic antidepressants (like Norpramin, Tofranil, Vivactil); the list goes on.

Despite the many studies proving the effectiveness of activated charcoal in treating drug overdose and poisoning, Cooney points out that few homes today have activated charcoal on hand as a ready antidote in such emergencies. 

According to the report, over half of accidental poisonings in the home occur involving children under the age of 6.  The poisonings that occur in victims under the age of 13 are predominately male, while the victims of the teen and adult population are predominately female.  The primary channel of exposure, ingestion. 

Five commonly used treatments of drug overdose/ poisoning in hospitals are also discussed by Cooney. 

  • Ipecac-induced emesis - which is a very pleasant way to describe a plant-based syrup that induces vomiting.
  • Gastric lavage – we know this as stomach pumping – the contents of the stomach is cleaned out by the insertion of a tube via the mouth or nose down into the stomach.
  • Administration of cathartics – which is a drug that accelerates… um… #2 in the bathroom.
  • Single & multi-dose activated charcoal – a mixture of powdered activated charcoal and water.
  • Combination of therapies

Cooney discusses a study (Robertson, 1962) where 250 patients given 20mL of ipecac syrup.  It was found that the average delay before emesis (forced vomiting) was 19 minutes.  That’s a long time, however, the time needed to perform a gastric lavage (stomach pump) is even longer.  For quickly absorbed drugs like barbiturates (sedative hypnotics), neither vomiting nor stomach pumping may be quick enough to be useful.

A common practice in the emergency department is to perform gastric lavage and follow up with activated charcoal.  Some of the drug/ poison is concealed in hard to reach recesses of the stomach and not accessible to the lavage tube.  Lavage, it seems, is often inefficient.  Both emesis and gastric lavage have been reported to have an efficiency percentage of 40 or less. One study has even reported that an average recovery of stomach content to be less than 30% from ipecac-induced emesis.

According to Cooney, activated charcoal absorbs a wide variety of substances and is non-toxic.  As long as it is sealed in an air tight container, it has an indefinite shelf-life.  It can be administered without difficulty and most kids, when forced to drink it, won’t spit it back in your face.

I chose to discuss some of the medical studies around activated charcoal this time because I wanted to illustrate the gravity of its importance blocking lethal absorption in the body in life or death situations.  I wanted to illustrate the weight of its importance since ancient times and how “modern medicine” is only recently getting on board with administering activated charcoal when it is needed most.

We’re not done though. More on activated (magic) charcoal next time.