Accidental administration of activated charcoal into the lung: aspiration by proxy

We report a case of accidental activated charcoal instillation into the lung of a 30-year-old man being managed for a cyclic antidepressant overdose. The patient was treated with multidose activated charcoal, and between his first and second doses, he pulled his nasogastric tube out of position. The tube was reinserted past the endotracheal tube into the right mainstem bronchus, and a dose of activated charcoal with sorbitol was administered into the lung. He subsequently developed an adult respiratory distress syndrome but gradually improved after bronchoscopic removal of charcoal and supportive care. He was discharged 14 days later.