Charcoal, Activated

Definition
Activated charcoal is a fine black odorless and tasteless powder made
from wood or other materials that have been exposed to very high
temperatures in an airless environment. It is then treated, or activated,
to increase its ability to adsorb various substances by reheating with
oxidizing gas or other chemicals to break it into a very fine powder.
Activated charcoal is pure carbon specially processed to make it
highly adsorbent of particles and gases in the body's digestive system.
Activated charcoal has often been used since ancient times to cure a
variety of ailments including poisoning. Its healing effects have been
well documented since as early as 1550 B.C. by the Egyptians.
However, charcoal was almost forgotten until 15 years ago when it
was rediscovered as a wonderful oral agent to treat most overdoses
and toxins.

Description
Activated charcoal's most important use is for treatment of poisoning.
It helps prevent the absorption of most poisons or drugs by the
stomach and intestines. In addition to being used for most swallowed
poisons in humans, charcoal has been effectively used in dogs,
rabbits, rats, and other animals, as well. It can also adsorb gas in the
bowels and has been used for the treatment of gas or diarrhea.
Charcoal's other uses such as treatment of viruses, bacteria, bacterial
toxic byproducts, snake venoms and other substances by adsorption
have not been supported by clinical studies. By adding water to the
powder to make a paste, activated charcoal can be used as an
external application to alleviate pain and itching from bites and stings.

Poisons and drug overdoses

It is estimated that one million children accidentally overdose on drugs
mistaken as candies or eat, drink, or inhale poisonous household
products each year. Infants and toddlers are at the greatest risk for
accidental poisoning. Activated charcoal is one of the agents most
commonly used for these cases. It can absorb large amounts of
poisons quickly. In addition, it is non-toxic, may be stored for a long
time, and can be conveniently administered at home. Charcoal works
by binding to irritating or toxic substances in the stomach and
intestines. This prevents the toxic drug or chemical from spreading
throughout the body. The activated charcoal with the toxic substance
bound to it is then excreted in the stool without harm to the body.
When poisoning is suspected the local poison control center should be
contacted for instructions. They may recommend using activated
charcoal, which should be available at home so that it can be given to
the poisoned child or pet immediately. For severe poisoning, several
doses of activated charcoal may be needed.
Activated charcoal is also used to induce vomiting in adults who have
attempted suicide by taking an overdose of antidepressants,
barbiturates, or benzodiazepine tranquilizers.

Intestinal disorders
In the past, activated charcoal was a popular remedy for flatus
(intestinal gas). Even before the discovery of America by Europeans,
Native Americans used powdered charcoal mixed with water to treat
an upset stomach. Although charcoal has been recommended as an
alternative treatment for flatus, however, studies done in the early
2000s have reported that it is not particularly useful in treating
intestinal gas. Such other measures as dietary changes or
biofeedback training are more effective in relieving patients'
symptoms.
Charcoal has also been used to treat such other intestinal disorders
as diarrhea, constipation, and cramps. There are few studies to
support these uses and there are also concerns that frequent use of
charcoal may decrease absorption of essential nutrients, especially in
children.

Other uses
Besides being a general antidote for poisons or remedy for gas,
activated charcoal has been used to treat other conditions as well.
Based on its ability to adsorb or bind to other substances, charcoal
has been effectively used to clean skin wounds and to adsorb waste
materials from the gastrointestinal tract. In addition, it has been used
to adsorb snake venoms, viruses, bacteria, and harmful materials
excreted by bacteria or fungi. However, because of lack of scientific
studies, these uses are not recommended. Activated charcoal, when
used together with other remedies such as aloe vera, acidophilus, and
psyllium, helps to keep symptoms of ulcerative colitis under control.
While charcoal shows some anti-aging activity in rats, it is doubtful if it
has the same effect in humans.
Apart from its medicinal applications, activated charcoal is used by
biologists to cool cell suspensions; by public health physicians to filter
disease organisms from drinking water; and by environmental
scientists to remove organic pollutants from ocean sediments.

Recommended dosage

For poisoning
Activated charcoal is available without prescription. In cases of
accidental poisoning or drug overdose, however, one should call an
emergency poison control center, hospital emergency room, or
doctor's office for advice. In case that both syrup of ipecac and
charcoal are recommended for treatment of the poison, ipecac should
be given first. Charcoal should not be given for at least 30 minutes
after ipecac or until vomiting from ipecac stops. Activated charcoal is
often mixed with a liquid before being swallowed or put into the tube
leading to the stomach. Activated charcoal is available as 1.1 oz (33
m) liquid bottles. It is also available in 0.5 oz (15 ml) container sizes
and as slurry of charcoal pre-mixed in water or as a container to which
water or soda pop can be added. Keeping activated charcoal at home
is a good idea so that it can be taken immediately when needed for
treatment of poisoning.
For acute poisoning, the dosage is as follows:

• Infants (under 1 year of age): 1 g/kg.

• Children (1-12 years of age): 15-30 g or 1-2 g/kg with
at least 8 oz of water.
 • Adults: 30-100 g or 1-2 g/kg with at least 8 oz of
water.

For diarrhea or gas

A person can take charcoal tablets or capsules with water or sprinkle
the content onto foods. The dosage for treatment of gas or diarrhea in
adults is 520-975 mg after each meal and up to 5 g per day.

Precautions
Parents should keep activated charcoal on hand in case of
emergencies.
Charcoal should not be given together with syrup of ipecac. The
charcoal will adsorb the ipecac. Charcoal should be taken 30 minutes
after ipecac or after the vomiting from ipecac stops.
Some activated charcoal products contain sorbitol. Sorbitol is a
sweetener as well as a laxative, therefore, it may cause severe
diarrhea and vomiting. These products should not be used in infants.
Charcoal may interfere with the absorption of medications and
nutrients such as vitamins or minerals. For uses other than for
treatment of poisoning, charcoal should be taken two hours after other
medications.
Charcoal should not be used to treat poisoning caused by such
corrosive products as lye or other strong acids or petroleum products
such as gasoline, kerosene, or cleaning fluids. Charcoal may make
the condition worse and delay diagnosis and treatment. In addition,
charcoal is also not effective if the poison is lithium, cyanide, iron,
ethanol, or methanol.
Parents should not mix charcoal with chocolate syrup, sherbet, or ice
cream, even though it may make charcoal taste better. These foods
may prevent charcoal from working properly.
Activated charcoal may cause swelling or pain in the stomach. A
doctor should be notified immediately. It has been known to cause
problems in people with intestinal bleeding, blockage or those people
who have had recent surgery. These patients should talk to their
doctor before using this product.
Charcoal may be less effective in people with slow digestion.
Charcoal should not be given for more than three or four days for
treatment of diarrhea. Continuing for longer periods may interfere with
normal nutrition.
Charcoal should not be used in children under three years of age to
treat diarrhea or gas.
Activated charcoal should be kept out of reach of children.

Side effects
Charcoal may cause constipation when taken for a drug overdose or
accidental poisoning. A laxative should be taken after the crisis is
over.
Activated charcoal may cause the stool to turn black. This side effect
is to be expected.
Patients should consult a doctor if they have pain or swelling of the
stomach.

Interactions
Activated charcoal should not be mixed with chocolate syrup, ice
cream, or sherbet to make it more palatable. These foods prevent the
charcoal from working properly.

Key terms
Adsorption — The binding of a chemical (e.g., drug or poison) to a
solid material such as activated charcoal or clay.
Antidote — A remedy to counteract a poison or injury.
Flatus — Gas or air in the digestive tract.