Container residue after activated charcoal administration in the emergency department

We hypothesized that sources of activated charcoal (AC) used as a form of gut decontamination in the treatment of drug overdose may deliver significantly less charcoal than expected because of retained charcoal and sorbitol (ACS) from the treatment of 50 consecutive overdose patients were collected. Health care personnel delivering the dose were unaware of the study hypothesis. A total of 82 containers were obtained in this manner. Each container was labelled to contain 25 g AC and 48 g sorbitol. Five unused containers of ACS were obtained as controls. Each container was thoroughly cleaned, and the contents vacuum filtered and washed with 1 L of tap water. The tared filter paper and charcoal was dried for 24 h and weighed. The average amount of charcoal retained in each used container (retained) was 0.549 g (range 0.318-1.637 g). This accounts for 2.2% of the 25 g dose expected to be delivered. The average amount of charcoal found in each unused container (actual) was 25.892 g. The delivered dose (actual minus retained) may be calculated as 101.4% of the expected 25 g dose. When using this formulation of ACS there is no significant difference between the amount of charcoal given to an overdose patient and the amount ordered for gut decontamination. Despite the poor suspension of charcoal in sorbitol and the less than ideal conditions under which it is given, the patient receives an adequate dosage of AC if it is ordered.