Activated Charcoal Administration in a Pediatric Emergency Department

Abstract

Despite published guidelines, children treated in an emergency department rarely received charcoal within 1 hour of ingestion. Gastric tube administration of charcoal varies by age and is partly subjective in its application. We found no evidence that excipient flavoring of charcoal improved success of administration. Pulmonary aspiration of charcoal, although uncommon, should be considered when assessing the risk of therapy. We offer a report of symptomatic constipation from single-dose charcoal.

Does Emergency Medical Services Transport for Pediatric Ingestion Decrease Time to Activated Charcoal?

“…In an earlier study of pediatric AC administration, 64% of patients were aged 0-6 years and 29% were aged 12-18 years. 12 In the current study, 63% of patients were aged 0-5 years and 31% were aged 13-18 years.…”

“…These numbers for young children were similar to previous reports. In a previous pediatric AC study, 60% of patients under age 6 years were male, 12 and in a recent analysis of pediatric ingestions treated in United States EDs, 55% of patients aged less than 5 years were male. 13 In the 13-18-year age group, 12% of patients were male and 88% were female.…”

“…These findings were similar to another pediatric ED study of AC administration in which 30% of patients arrived to the ED within 45 minutes after ingestion, 7.8% (21 patients) received AC within 60 minutes after ingestion, and 55% of children received activated AC within 60 minutes after triage. 12 It is speculated that delay to charcoal administration in the current study resulted because of suboptimal wait times from triage to ED treatment room placement and from ED treatment room placement to physician evaluation. During the study period, there was no triage-based protocol to facilitate and expedite the administration of AC in cases of ingestion for which AC was indicated.…”

“…29 Toxicology experts and investigators argue that the kind of suboptimal time intervals seen in this study warrant a reevaluation of the triage and ED processes that mitigate timely administration of AC when clinically indicated. 11,12,30 Specifically, triage protocols for charcoal availability and initiation should be considered. Emergency medical services systems also have the potential to minimize delays in the setting of pediatric toxic ingestion.…”

Peanut proteins: Applications, ailments and possible remediation

“…Activated charcoal (AC) is commonly given for gastric decontamination to potentially poisoned children in U.S. emergency departments [52]. AC may be a safe and effective method of rendering peanut allergens unavailable for absorption in the gastrointestinal tract.…”