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Medical Author:

John P. Cunha, DO, FACOEP

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Activated charcoal exerts its effects by absorbing a wide variety of drugs and chemicals. Adsorption is a process in which atoms and molecules move from a bulk phase (such as a solid, liquid, or gas) onto a solid or liquid surface. In other words, the toxic substance attaches to the surface of the charcoal. Because charcoal is not "digested," it stays inside the GI tract and eliminates the toxin when the person has a bowel movement.

• This mechanism of action should not be confused with absorption. Absorption occurs when a substance passes into or through a tissue, like water passing into a sponge. Once the chemical or drug has been absorbed by the GI tract, activated charcoal can no longer retrieve the toxic ingestion. It will only attach to substances that are still inside the stomach or intestines.
  
  
• The charcoal is "activated" because it is produced to have a very fine particle size. This increases the overall surface area and adsorptive capacity of the charcoal. It is produced by adding acid and steam to carbonaceous materials such as wood, coal, rye starch, or coconut shells. To put this in perspective, one standard 50-gram dose of activated charcoal has the surface area of 10 football fields.
  
  
• Activated charcoal is often combined with sorbitol (a substance that stimulates the bowels to move, like a laxative) to shorten the amount of time to move through the system and reduce the possibility of constipation. However, to avoid adverse effects, sorbitol is not given with every dose of activated charcoal.
  
  
• All efforts should be made to reduce adsorption of severely toxic substances, as activated charcoal  does not bind as well with these substances:
  
  
  • Lithium (Eskalith, Lithobid), strong acids and bases, metals and inorganic minerals such as sodium, iron, lead, arsenic, iodine, fluorine, and boric acid.
    
    
  • Alcohol (such as ethanol, methanol, isopropyl alcohol, glycols, and acetone)
    
    
  • Hydrocarbons (such as petroleum distillates and plant hydrocarbons such as pine oil)
  
  
• Activated charcoal does not irritate the mucous membranes of the GI system. In addition to adsorption of toxins, activated charcoal also adsorbs food nutrients, vitamins, and minerals. However, this short-term effect is not a concern when activated charcoal is used to treat poisoning.

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