Say the word “charcoal” to almost any American and the immediate mental image will be steaks on a grill. However, say that same word in an emergency department and the image will be drastically different.
A squeeze bottle of a black, thick solution; a nasogastric tube, and either a combative patient or an unconscious one will be the scenario. The use of activated charcoal in acute poisoning is an age-old practice dating back as far as as 1500 B.C.1
Medicinal activated charcoal is available in many different forms. It is a carbon molecular structure made from a variety of inert materials that have been treated with intense heat and oxygen, making it “activated.”1 This process yields a highly porous particle. It is estimated that a teaspoon of activated charcoal has a surface area of nearly 10,000 square feet.1
The utility of activated charcoal in the treatment of acute poisoning and overdose is well-established. When administered orally, the porous particles selectively bind to (absorb) the toxic chemical. This carbon/toxin complex then passes out of the body intact.
When given appropriately, activated charcoal absorbs up to 60% of the chemical toxins it encounters. The provider must understand, however, that this complex is unstable and can reverse over time. Consequently, a cathartic such as sorbitol is frequently coadministered to speed gastric emptying.2,3
Once the absorptive capacity of activated charcoal was established, investigators studied the possibility of using this substance to absorb other undesirable compounds in the body, such as cholesterol. One active control trial compared the efficacy of cholestyramine (Locholest, Prevalite, Questran) and activated charcoal in six patients with known hyperlipidemia.4
After a one-week dietary control, the patients were given three weeks of each treatment on widely separate occasions. Activated charcoal reduced plasma cholesterol levels by an average of 5% more than did the cholestyramine. Since that time, however, more rigorous trials have failed to show any favorable difference between the two therapies.
This article originally appeared on Clinical Advisor