Activated charcoal administration in a pediatric emergency department

Activated charcoal is the commonest form of gastrointestinal decontamination offered to potentially poisoned children within United States emergency departments. Our aim was to describe this practice with regard to timing, route of administration, use of flavoring agents, and occurrence of adverse events other than vomiting.

Descriptive data were prospectively collected from consecutive administrations of single-dose activated charcoal, within an urban, academic pediatric emergency department, over a period of 2.5 years.

Two hundred seventy-five subjects were enrolled. The median time elapsed between ingestion and emergency department arrival was 1.2 hours. Although 55% of children were administered charcoal within 1 hour of emergency department presentation, only 7.8% received charcoal within 1 hour of poisoning exposure. Forty-four percent of children younger than 6 years, 50% of 6-year to 12-year olds, and 89% of 12-year to 18-year olds drank the charcoal voluntarily (P < 0.01). Medical staff chose not to offer charcoal orally to 42 asymptomatic children among the 176 subjects under the age of 6 years. Of the 114 young children offered oral charcoal, 36 (32%) refused or were intolerant. Nurses added flavoring agents to the charcoal in 59% of oral administrations, but this act did not enhance observed palatability. Among children younger than 6 years, the median time from first sip to complete ingestion of charcoal slurry was 15 minutes. One pulmonary aspiration event and a case of constipation were noted.

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.