Selection of activated charcoal products for the treatment of poisonings

Effects of Activated Charcoal on Growth, Immunity, Oxidative Stress Markers, and Physiological Responses of Nile Tilapia Exposed to Sub-Lethal Imidacloprid Toxicity

Simple Summary

Finding a suitable feed supplement is important for maintaining fish health and sustainability of the aquaculture industry. From these supplements, research studies have shown that activated charcoal (AC) has been extensively used for veterinary and aquaculture objectives as a “Universal Antidote” against several toxicants and aquatic pollutants. Therefore, the mitigating roles of dietary supplementation with different AC levels on physiological responses of Nile tilapia exposed to sub-lethal imidacloprid (IMID) toxicity were evaluated. The findings of this study revealed that dietary supplementation with 14.30 g AC/kg diet positively modulated the toxic impacts of IMID-intoxicated fish.

Abstract

The existing study was designed to assess the influences of dietary activated charcoal (AC) on the growth performance, immune responses, antioxidative status, and its mitigating roles against the physiological responses of Nile tilapia exposed a sub-lethal dose of a neonicotinoid agriculture pesticide, namely, as imidacloprid (IMID). Nile tilapia juveniles were fed on diets supplemented with graded AC levels as 0 (control), 5, 10, 15, and 20 g/kg diet for eight weeks. Growth, hemato-biochemical indices, and antioxidant and immune responses of fish in all groups were evaluated at the end of the feeding experiment. Afterward, fish in all experimental groups were subjected to a sub-lethal dose of IMID (0.0109 μg/L) for two weeks. Then, fish mortalities, stress indicators, and IMID residual levels in liver and flesh were examined. Results of the feeding experiment showed that total feed intake, weight gain, final body weights, and feed efficiency ratio were significantly increased in all AC groups compared with the control group. The survival rate was 100% in all experimental groups. No statistical differences were observed in the hematological picture of all experimental groups except the lymphocyte count, which was significantly increased in all AC groups compared to the control group. Total protein, albumin, globulin, nitric oxide levels, lysozyme, and respiratory burst activities were significantly increased in all AC groups. Serum alanine transaminase, aspartate transaminase, alkaline phosphatase activities, and malondialdehyde (MDA) levels were significantly decreased in all AC groups compared with the AC0 group. After exposure to a sub-lethal dose of IMID, survival rates were significantly elevated, and IMID residual levels in liver and flesh were significantly decreased in all AC groups than in the control group. Moreover, second-order polynomial regression showed that dietary supplementation with 14.30 g AC/kg diet resulted in the lowest blood glucose and serum MDA levels. Conclusively, we suggest dietary supplementation with 14.30 g AC/kg diet to modulate physiological responses of Nile tilapia to sub-lethal IMID toxicity.

Risk factors for emesis after therapeutic use of activated charcoal in acutely poisoned children

OBJECTIVES

Vomiting frequently complicates the administration of activated charcoal. The incidence of such vomiting is not defined precisely in the pediatric population. Little is known about the patient-, poison-, or procedure-specific factors that contribute to emesis of charcoal. This study aimed to estimate the incidence of vomiting subsequent to therapeutic administration of charcoal to poisoned children < or =18 years of age and to examine the relative contributions of several risk factors to the occurrence of vomiting.

METHODS

Data were collected on a prospective cohort of 275 consecutive children who were treated with activated charcoal for acute poisoning exposure. The study was set in the emergency department of an urban, tertiary-care children's hospital. Sorbitol content of the charcoal was alternately assigned. Potential risk factors for vomiting were recorded prospectively, and the occurrence of vomiting within 2 hours of charcoal administration was measured.

RESULTS

A total of 56 (20.4%) of 275 patients vomited. Median time to vomiting was 10 minutes. Previous vomiting (relative risk: 3.41; 95% CI: 1.48-7.85) and nasogastric tube administration (relative risk: 2.40; 95% CI: 1.13-5.09) were found to be the most significant independent risk factors for vomiting. The increased risk among children >12 years of age, compared with younger children, approached significance. Sorbitol content, large charcoal volumes, or fast administration rates did not increase vomiting risk significantly.

CONCLUSIONS

One of every 5 children who are given activated charcoal within our pediatric emergency department vomited. Children with previous vomiting or nasogastric tube administration were at highest risk, and these factors should be accounted for in future investigation of antiemetic strategies. Sorbitol content of charcoal was not a significant risk factor for emesis.

Prospective single blinded randomised controlled trial of two orally administered activated charcoal preparations

OBJECTIVES

To compare two activated charcoal preparations (Carbomix and Actidose-Aqua) in terms of amount ingested and incidence of vomiting after ingestion.

METHODS

Single blinded prospective randomised controlled trial.

RESULTS

The mean amount of charcoal ingested was Carbomix 26.5 g, Actidose-Aqua 19.5 g. The mean difference was 7 g (95% confidence interval (CI) 1.5 to 12.4 g). The incidence of vomiting was for the Carbomix 6% and the Actidose-Aqua 8%. The mean difference in vomiting was 2% (95% CI -0.8 to 4.8)

CONCLUSIONS

Carbomix administration results in an increased amount of activated charcoal ingested after oral administration. Rates of vomiting after activated charcoal administration were low when compared with previously reported rates.

Position statement: single-dose activated charcoal. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists

In preparing this Position Statement, all relevant scientific literature was identified and reviewed critically by acknowledged experts using agreed criteria. Well-conducted clinical and experimental studies were given precedence over anecdotal case reports and abstracts were not usually considered. A draft Position Statement was then produced and subjected to detailed peer review by an international group of clinical toxicologists chosen by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. The Position Statement went through multiple drafts before being approved by the boards of the two societies and being endorsed by other societies. The Position Statement includes a summary statement for ease of use and is supported by detailed documentation which describes the scientific evidence on which the Statement is based. Single-dose activated charcoal should not be administered routinely in the management of poisoned patients. Based on volunteer studies, the effectiveness of activated charcoal decreases with time; the greatest benefit is within 1 hour of ingestion. The administration of activated charcoal may be considered if a patient has ingested a potentially toxic amount of a poison (which is known to be adsorbed to charcoal) up to 1 hour previously; there are insufficient data to support or exclude its use after 1 hour of ingestion. There is no evidence that the administration of activated charcoal improves clinical outcome. Unless a patient has an intact or protected airway, the administration of charcoal is contraindicated.

Advantage of high-surface-area charcoal for gastrointestinal decontamination in a human acetaminophen ingestion model

OBJECTIVE

To compare the abilities of low-surface-area (LSA) vs 2 types of high-surface-area (HSA) activated charcoal given orally to adsorb acetaminophen in the gastrointestinal (GI) tract, as demonstrated by the impact of these agents on the serum levels and area under the curve (AUC) in a simulated human overdose model.

METHODS

The main arm of the study was a prospective double-blind crossover trial in which 6 volunteers, serving as their own controls, ingested acetaminophen (50 mg/kg), followed randomly in 10 minutes by either powdered LSA charcoal (950 m2/g) or powdered HSA charcoal (2,000 m2/g) in a charcoal:drug ratio of 8:1. In a second arm of the study, 3 subjects additionally ingested an equal dose of a granular preparation of the HSA charcoal. Serial serum acetaminophen levels were analyzed at various intervals (30, 60, 90, 120, 180, 240, and 300 minutes postingestion), and a 5-hour AUC was calculated. The subjects also rated the charcoal preparations for palatability.

RESULTS

Serum acetaminophen levels were lower at all measured times in the groups receiving both forms of the HSA charcoal vs the LSA product. With the powdered HSA charcoal, comparison serum levels were significantly lower at 120 minutes postingestion and all times thereafter (p < 0.05), reaching high significance at 4 and 5 hours (p < 0.001). The subjects receiving the granular HSA charcoal also had consistently lower serum acetaminophen levels than did those receiving the LSA product, and the difference in mean serum levels was significant at the 4- and 5-hour sample (p = 0.012). Compared with the LSA charcoal, at the 4-hour postingestion sample, serum acetaminophen levels were reduced by 44% to 85% by the powdered HSA charcoal. The total AUC for the 5-hour study period was also significantly reduced by the powdered HSA product (p = 0.005) and the granular HSA product (p = 0.043). All the subjects rated the powdered HSA charcoal to be more palatable and easier to drink than the powdered LSA charcoal.

CONCLUSION

The surface area of oral activated charcoal is a major determining factor in its ability to limit acetaminophen absorption and to fulfill its adsorptive role in GI decontamination. In a human acetaminophen overdose model, 2 types of HSA charcoal, when compared with equal doses of LSA charcoal, significantly reduced serum levels and total acetaminophen absorption as measured by the AUC.

Correlation of drug pharmacokinetics and effectiveness of multiple-dose activated charcoal therapy

STUDY OBJECTIVE

To evaluate an animal model of multiple-dose activated charcoal (MDAC) therapy and correlate the pharmacokinetic properties of four drugs with the efficacy of MDAC.

DESIGN

Prospective, randomized, controlled, crossover design.

SETTING

A university animal research facility.

PARTICIPANTS

Seven female pigs (15 to 22 kg) with an indwelling central venous line and gastrostomy tube.

INTERVENTIONS

Acetaminophen (30 mg/kg), digoxin (30 micrograms/kg), theophylline (8.9 mg/kg), and valproic acid (18 mg/kg) were simultaneously administered intravenously over 12 minutes. In the experimental arm, 25 g activated charcoal was administered at 0, 2, 4, 6, 12, 18, 24, and 30 hours through the gastric tube. In the control arm, an equal volume of water was given at the same times. Blood specimens were obtained over 36 hours to measure serum drug concentrations.

RESULTS

Each drug exhibited enhanced elimination (P < .01) in the MDAC group except valproic acid. Lower intrinsic clearance was correlated (P < .05) with increased systemic elimination during the charcoal arm. Volume of distribution, half-life, and protein binding were not significantly correlated with charcoal-enhanced systemic drug elimination.

CONCLUSION

The response of a drug to MDAC may be affected by its intrinsic clearance. The restrictive nature of the protein binding of valproic acid may be responsible for its lack of response. Results with the porcine model are consistent with the effects observed in human beings.

In vitro adsorption of phenobarbital, chlorpheniramine maleate, and theophylline by four commercially available activated charcoal suspensions

Four commercially available antidotal activated charcoal suspensions (Actidose Aqua, InstaChar, LiquiChar, and CharcoAid 2000) were evaluated with respect to their abilities to adsorb three test drugs in vitro from simulated gastric fluid. Different volumes of each suspension were added to glass vials containing 20 mL of stock solutions of each drug. The vials were shaken for a time more than sufficient to ensure adsorption equilibrium, then the charcoal was removed from the samples by filtration. The filtrates were analyzed by ultraviolet spectroscopy to determine the residual drug concentrations. The product containing a 2000 m2/g charcoal (CharcoAid 2000) adsorbed more drug per unit volume of suspension than did the other three products, which contained 900 m2/g charcoal and which were all similar in performance.