Activated Charcoal
Description
Activated charcoal has been scientifically proven to bind, and thus prevent the absorption of, many ingested drugs and chemicals from the gastrointestinal tract. Charcoal also provides relief from a multitude of other gastrointestinal problems, including bad breath, lower intestinal gas (flatulence) and abdominal bloating.
Charcoal to treat toxic poisonings and overdoses was first reported in the early 18th century. Clinical applications became more widespread nearly one hundred years later. Probably the most dramatic demonstration of the action of charcoal occurred in 1831 when Tovery swallowed a lethal dose of strychnine mixed with charcoal in front of the French Academy of Medicine. Tovery suffered no ill effects from strychnine because of the simultaneous ingestion of charcoal. To date many studies have been published describing the adsorptive characteristics and clinical benefits of charcoal.
Charcoal is produced from a variety of materials. Most charcoals today are made from coke, coal, sawdust, peat, wood, paper mill wastes, coconut shells and bones. Charcoals made from vegetable substances, such as coal or wood contain about ninety percent carbon. By comparison, bone charcoal contains about 11% carbon.
Charcoal can be produced at home by burning wood outdoors in a fireplace. Once the wood is burning brightly, it should be covered with tin, and dirt covered over the tin. This dome will allow the heat to continue without sufficient oxygen, burning off the soft parts and leaving the hard parts behind. These charred hard pieces of wood, or charcoal, can then be placed in a bag and pulverized into fine granules. These granules can be placed in a blender and ground into a fine powder. Commercial charcoal tablets are not nearly as effective in adsorbing drugs as finely powdered charcoal preparations. Under no circumstances should charcoal briquettes, such as those used in barbeques, be used internally; numerous toxic fillers may have been applied to the briquettes to ensure ignition after lighting.
Charcoal has both commercial and medicinal uses. Medicinal charcoals, such as activated charcoal or superactivated charcoal, are slightly different in their method of manufacture.
Activated charcoal is nearly pure carbon. It is considered an improved form of charcoal for therapeutic usage. The manufacturing method was discovered at the beginning of the 20th century. Activated charcoal is produced by the controlled burning of wood, bones, or a variety of carbon-containing materials, after which an oxidizing gas, such as steam, oxygen, carbon dioxide, is introduced to raise the temperature even further. Thereafter certain acids and chemicals are introduced, to remove any remaining impurities. This process increases the adsorptive power of the charcoal by increasing the network of exceedingly small pores in the bone or wood. The quantity of these fine pores determines the therapeutic value of the charcoal.
Coffee charcoal is approved by the German Commission E as a medicinal herb.
Method of Action
The efficacy of activated charcoal in the treatment of poisonings and overdoses is due to direct adsorption of the toxic substance in the gastrointestinal tract. Activated charcoal will adsorb most drugs and toxins, but not all compounds are well adsorbed. Activated charcoal can interfere with the enterohepatic or gastroenteral recirculation, back-diffusion or both of toxic substances out of the systemic circulation into the gut via the gastrointestinal mucosa. "Several lines of evidence reinforce the importance of the use of activated charcoal as the cornerstone of therapy for a poisoned patient," wrote Drs. Derlet and Alberston, in a review of the medical justification for the use of activated charcoal.
Activated charcoal grains, which are approximately twice as potent as the tablets, have thousands of crevices useful for adsorption of materials, gases, foreign proteins, body wastes, chemicals and drugs. The total surface area of the sum of the particles in a small cube of charcoal only 2/5th of an inch in size on each side have been calculated to be one thousand square meters, an area equal in size to 33 square yards. This tremendous surface area allows activated charcoal to adsorb a significant amount of material, such as toxins or poisons. More technically, activated charcoal has a surface area of 1,000 m2 per gram, while experimental activated charcoal with surface areas up to 3,500 m2 have been manufactured.
Charcoal reaches its maximum rate of adsorption within one minute after ingestion. Charcoal forms a stable complex with toxic substances, preventing the toxins from degradating or dissociating further down the gastrointestinal tract.
Activated charcoal is very well tolerated and easily administered. It adsorbs well at body temperature. Simple acids and bases are easily absorbed. It is not effective in alcohol (ethanol) intoxication, and of little value with caustic materials such as lye.
Therapeutic Approaches
Charcoal has been used therapeutically in a variety of ways: as a charcoal poultice or bath to treat bites and sting, orally as an antidote, to decrease fecal odors, for infections, or to reduce the symptoms or treat intestinal gas (flatulence), abdominal pain, diarrhea or indigestion. Lavage of the stomach has also been used to treat poisonings.
In a recent medical clinical review, activated charcoal was favored over gastric emptying in the management of poisoned patients. Activated charcoal is widely used in the treatment of overdoses and poisonings in conjunction with gastric emptying at hospitals. In the past, such administration of charcoal was generally limited to a single dose. However, in recent years, it has been useful to recommend frequent repeated doses of charcoal, especially for the victim of serious toxic ingestion.
It is estimated 10 grams (1 tablespoon) of activated charcoal can absorb only about 3 to 7 grams of materials. This means it is necessary to ingest six or seven times as much charcoal as the ingested toxin or poison by weight. Studies have shown after charcoal has been ingested, nearly 50% of its effectiveness is lost in the stomach, and a further 30% reduction occurs due to bile, and only a very minor additional reduction due to duodenal juices. Better results are always experienced if the finer powdered charcoal is administered quickly after ingestion of the poison or toxin. If given by lavage by a physician, it is preferable to achieve an activated charcoal-to-drug toxin ratio of about 10:1.
The following substances have been shown to be absorbed by charcoal:
| Acetaminophen | Kerosene |
| Aconitine | Lead acetate |
| Alcohol | Mefenamic acid |
| Amanita phalloides | Meprobamate |
| Amphetamine | Mercuric chloride |
| Antimony | Methylene blue |
| Antipyrine | Methyl salicylate |
| Arsenic | Morphine |
| Aspirin | Muscarin |
| Atenolol | Narcotics |
| Atropine | Neguvon |
| Barbital | Nicotine |
| Barbiturates | Nortriptyline |
| Cantharides | Opium |
| Camphor | Parathion |
| Chlordane | Penicillin |
| Chloroquine | Pentobarbital |
| Chlorpromazine | Phenophthalein |
| Cobra venom | Phenol |
| Cocaine | Phenylpropanolamine |
| Colchicine | Potassium cyanide |
| Delphinium | Potassium permanganate |
| 2,4-dichlorophenoxyacetic acid | Primaquine |
| Digitalis | Propantheline |
| Diphenylhydantoin | Proxyphene |
| Diphenoxylates | Quinacrine |
| Diphtherial toxin | Quinidine |
| Elaterin | Quinine |
| Ergotamine | Radioactive substances |
| Ethchlorvynol | Salicylamide |
| Gasoline | Salicylates |
| Glutethimide | Secobarbital |
| Hemlock | Selenium |
| Hexachlorophene | Silver |
| Imipramine | Stramonium |
| Iodine | Strychnine |
| Ipecac | Sulfonamides |
| Isoniazid | Veratrine |
| Some silver and antimony salts |
Each year, thousands of children under the age of five are poisoned by aspirin. Studies have shown if no charcoal is given to the poisoned child, 99.6% of the aspirin is absorbed from the gastrointestinal tract. In those children receiving 10 grams (1 tablespoon) of charcoal, only 58.9% of the aspirin was absorbed. However, if the adminstration of charcoal is delayed by one hour, 78.5% of the aspirin is absorbed.
A charcoal tablet is effective against bad breath when left in the mouth for up to 30 minutes following cleansing of the teeth, tongue and gums with a soft brush. In some countries, charcoal is used for regularly cleaning teeth. It seems to be effective against periodontal disease.
Flatulence (released lower intestinal gas) and abdominal distension have been shown to respond readily to charcoal. In a double-blind trial on two separate populations in the U.S., efficacy of activated charcoal in reducing lower intestinal gas and accompanying symptoms was investigated. In comparison to the placebo, activated charcoal significantly reduced breath hydrogen levels in both populations groups. Symptoms of bloating and abdominal cramps attributable to gaseousness were also significantly reduced in both groups by activated charcoal. In cases of lower intestinal gas, four to eight capsules of charcoal a day are recommended.
In patients who have colostomies or ileostomies, fecal odors can be significantly reduced by taking charcoal three times daily. No undesirable effects have been associated with long-term ingestion of charcoal.
Compounds poorly absorbed or not absorbed by charcoal are:
| Alkali | Ferrous Sulfate |
| Aminoglycoside antibiotics | Malathion |
| Boric acid | Mineral acids |
| Cyanide | N-methyl carbamate |
| Dichlorodiphenyl-trichloroethane (DDT) | Tolbutamide |
| Electrolytes | Water-insoluble compounds such as methanol |
| Ethanol |
New roles for the use of activated charcoal in poisoning have emerged in recent years. This involves the concept of lowering serum concentrations of already systemically absorbed drugs or poisons. This tends to reduce the serum half-life of the toxin. This effect has been demonstrated after experimental adminstration of toxic levels of phenobarbital and phenobaritone, theophylline, digoxin and diazepam. The reduction in serum half-life after oral administration of activated charcoal was nearly 50% for each drug compared with controls. With some toxins such as atenolol, charcoal reduces intestinal absorption by as much as 95%. One explanation for this remarkable effect is the ability of activated charcoal to bind conjugated drug before hydrolysis or to free conjugated drug before reabsorption. Back-diffusion of free drug from the systemic circulation across the gastrointestinal tract into the intestinal fluids, and finally, binding to the activated charcoal in the gut. Coma due to diazepam toxicity was completely reversed within 12 hours after adminstration of activated charcoal, and the serum half-life of the drug was dramatically reduced from 195 to 18 hours during charcoal administration.
Gastrointestinal dialysis is the term proposed for repeated doses of activated charcoal to disrupt enterohepatic loops, and to strengthen back-diffusion of drugs into the gastrointestinal tract while increasing elimination. An example would be the effect of repeated oral administration of activated charcoal following accumulation of either amitriptyline or nortriptyline. With repeated oral doses, charcoal increases the rate of elimination of these substances to some extent, probably by interrupting enterohepatic or enteroenteric circulation.
The use of such treatment for severe overdoses, including intravenously introduced drug overdoses, is considered a major advancement in clinical toxicology. These advances in the use of activated charcoal have been made with the use of the new form of superactivated charcoal containing a greater surface area per gram. This surface area is approximately three times as much as the older forms of activated charcoal. Doses of approximately 20 grams of superactivated charcoal are administered every two hours for maximum effect. These findings also have been recommended for the treatment of sustained release formulation poisonings.
Clinicians have been criticized in the medical literature for failing to use charcoal in the treatment of intoxications, this failure having resulted in at least one preventable death of a patient from salicylate poisoning in Ontario, Canada.
Coffee charcoal has approval status by the German Commission E for use in diarrhea.
References:
Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.
Toxicity Factors
The medical literature contains occasional reports of bowel irritation in sensitive individuals with inflammatory states who have ingested charcoal. In some individuals, transit time of the feces has been delayed after oral ingestion of charcoal.
A case was reported recently of gastrointestinal obstruction associated with multiple-dose activated charcoal. A carbamazepine-intoxicated patient received 240 grams of activated charcoal and a total of 600 ml magnesium citrate, resulting in development of small-bowel obstructions.
It may also be inhaled during administration, especially by children. (Givens, 1992)
There are no other reported contraindications to the use of charcoal. No deaths have been attributed to the use of charcoal as a poultice, by lavage or through oral administration. If the skin is broken, applying a charcoal poultice may leave a tattoo in the dermis after healing. Other poultices, such as comfrey may be a better choice to avoid such staining of the skin.
Charcoal does not adsorb nutrients. This has been shown in studies involving rats and sheep given charcoal with or without their meals. Charcoal given to sheep for 6 months did not cause a significant loss of nutrients, nor were any postmortem abnormalities found in the gastrointestinal system.
This does not however infer that charcoal can be taken over many months or years in humans. Too few studies to date have examined the long term nutritional or gastrointestinal effect of charcoal subsequent to long-term ingestion or administration. However, no report in the literature could be found of adverse effects of charcoal ingestion for three months or less.
Allergic reactions to charcoal have not been reported.
Average daily dosages for Coffeee charcoal in Germany are: 9 g.
References:
Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.
Givens, T et al., Pulmonary aspiration of activated charcoal: a complication of its misuse in overdose management. Pediatr. Emerg. Care, 1992, 8(3):137.
Note: This Herbal Preparation information is a summary of data from books and articles by various authors. It is not intended to replace the advice or attention of health care professionals.
References
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