Davis's Drug Guide for Nurses, Tenth Edition

activated charcoal
Acta-Char Liquid-A , Actidose-Aqua, Aqueous Charcodote, Charac-50, CharcoAid 2000, Charcodote, Insta-Char, Insta-Char Aqueous Suspension, Liqui-Char, SuperChar Aqueous

Classification
Therapeutic: antidotes
Pharmacologic: adsorbents

Pregnancy Category C

Copyright © 2007 by F.A. Davis Company

Indications
Acute management of many oral poisonings following emesis/lavage.

Action
Binds drugs and chemicals in the GI tract. Therapeutic Effects: Decreased intestinal absorption of drugs or chemicals in the overdose situation.

Pharmacokinetics
Absorption: None
Distribution: None
Metabolism and Excretion: Excreted unchanged in the feces
Half-life: Unknown

TIME/ACTION PROFILE (antidote)

ROUTE	ONSET	PEAK	DURATION
PO	within min	unknown	4–12 hr

Contraindications/Precautions
Contraindicated in: No known contraindications.
Use Cautiously in: Poisonings due to cyanide, corrosives, ethanol, methanol, petroleum distillates, organic solvents, mineral acids, or iron. Endoscopic examination (observation will be obscured).

Adverse Reactions/Side Effects*
*CAPITALS indicate life threatening; underlines indicate most frequent.

GI: black stools, constipation, diarrhea, vomiting.

Interactions
Drug–Drug: Other drugs including ipecac syrup and laxatives will be adsorbed by charcoal and as a result will not be systemically absorbed from the GI tract.
Drug–Food: Milk, ice cream, or sherbet will decrease the ability of charcoal to absorb other agents.

Route/Dosage
Antidote
PO (Adults): 25–100 g (may be repeated q 4–6 hr).
PO (Children 1–12 yr): 25–50 g (may be repeated q 4–6 hr).
PO (Children <1 yr): 1 g/kg (may be repeated q 4–6 hr).

Availability
Powder: 15-, 25- 30-, 40-, 120-, 125-g 240-g^OTC containers. Oral suspension: 12.5 g/60 ml^OTC, 15 g/72 ml^OTC, 15 g/120 ml^OTC, 25 g/120 ml^OTC, 30 g/120 ml^OTC, 50 g/240 ml^OTC, 15 g/120 ml^OTC, 25 g/125 ml^OTC, 50 g/225 ml^OTC, 50 g/250 ml^OTC. In combination with: sorbitol (Actidose with Sorbitol), Charcoaid, Pediatric Charcodote, Charac-tol, (Charcodote TFS)^OTC.

NURSING IMPLICATIONS

Assessment

Assess neurologic status; administer only if patient is alert (unless airway is protected).

Inquire as to the type of drug or poison and time of ingestion.

Consult reference, poison control center, or physician for symptoms of toxicity of ingested agent(s).

Monitor blood pressure, pulse, respiratory and neurologic status, and urine output as indicated by toxicity of agent(s). Notify physician if symptoms persist or worsen.

Lab Test Considerations: Chronic use may impair absorption of essential nutrients. This may result in decreased mineral or electrolyte levels.

Potential Nursing Diagnoses
Risk for self-directed violence (Indications).
Risk for injury (Indications).

Implementation

Treatment of Poisoning: Activated charcoal is most effective if administered within 30 min of ingestion of drug or poison. Dosage may be repeated for drugs subjected to enterohepatic elimination to minimize further absorption

If syrup of ipecac is used, administer ipecac first and wait until emesis occurs before administering activated charcoal.
.

PO: Mix dose in 6–8 oz water; administer as a slurry (unless using suspension with or without sorbitol). Do not administer with milk products (milk, ice cream, or sherbet). May need to be diluted with additional water to be thin enough to administer through a nasogastric tube

Shake oral suspension well before administration.

Rapid ingestion may cause vomiting. If vomiting occurs shortly after administering dose, confer with physician about repeating dose.

Do not administer other oral drugs for 2 hr before or after administering activated charcoal.

Slurry is constipating; physician may order a laxative to speed removal of the drug. May not be required with products containing sorbitol.
.

Patient/Family Teaching

Inform patient that stools will turn black.

Poisoning: When counseling, discuss methods of prevention, need to confer with poison control center, physician, or emergency department before administering, and need to bring ingested substance to emergency department for identification.

Evaluation/Desired Outcomes