Activated charcoal--past, present and future

Poisoned patients were first treated with charcoal more than 150 years ago. Despite its almost universal acceptance today, activated charcoal's role has been overshadowed by the emphasis on treating poisoned patients first with gastric emptying. We review the current use of activated charcoal and recent studies that suggest that activated charcoal may be the single most effective treatment in many types of poisoning. New explanations for the mechanisms of action include "back diffusion" and disruption of enterohepatic loops. Clinical data endorse a new and aggressive role for activated charcoal in the management of poisoned and overdosed patients.