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Frequently Asked Questions for Pharmacists on Poisonings

Q: What's the proper way to respond to childhood poisonings?

A: Activated Charcoal is produced by burning wood pulp, coconut and other organic matter, then heating it with steam at 600-900°C. This makes a porous, expansive network with a large surface area that can adsorb toxic substances. Activated Charcoal typically has a surface area of 950 to 2000 m²/g. Charcoal capsules, tablets, and briquettes for grilling are NOT equivalent and should never be used as a substitute for activated charcoal.

The Carolinas Poison Center is recommending that parents keep a bottle of Activated Charcoal in the home for every child under the age of six. Activated Charcoal is now a first choice for home gastrointestinal decontamination of pediatric poisonings. The departure from the use of Syrup of Ipecac is based on the recent availability of OTC Activated Charcoal as well as lack of data from human and animal studies that shows any clinical benefit from using Syrup of Ipecac (Position Statement: Ipecac Syrup. Clinical Toxicology: 35(7), 699-709; 1997).

The recommended dose of Activated Charcoal in children is 1 g/kg without a cathartic. The 12.5 g or 15 g containers should be sufficient for pharmacists to recommend parents and caregivers purchase. Neither Activated Charcoal nor Syrup of Ipecac should be recommended without the advice of a poison center or pediatrician. There are many instances in which the child has not ingested a sufficient amount of toxin to need decontamination and can simply be observed. In addition, neither agent should be used for caustics or hydrocarbons, when there is risk of airway compromise, or when too much time has elapsed for the toxin to be available in the gastrointestinal tract.

The staff of the Carolinas Poison Center can answer any questions regarding use of Activated Charcoal or assist in the handling of emergency poisonings. The emergency number is (800) 222-1222 available statewide, (704) 355-4000 in the Charlotte/Mecklenburg County area. For non-emergency questions, the business number is (704) 395-3795.

The Carolinas Poison Center is the state designated poison resource for all of North Carolina, and is certified as a Regional Poison Center by the American Association of Poison Control Centers. Specially trained nurses and pharmacists are available on a 24-hour basis to assist with emergency poisonings. In addition, board-certified medical toxicologists are available for physician consultation.

The above item was submitted by Anna M. Rouse, R.Ph., CSPI,
Assistant Director, Carolinas Poison Center


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