Dear Pharmacist, Doctor,
There continues to be a shortage of aqueous activated charcoal suspensions approved for use as an adsorbent for gastrointestinal decontamination of the poisoned patient in select circumstances.
Health Canada has approved several aqueous activated charcoal suspensions; each is assigned a unique Drug Identification Number (DIN). Health Canada also approves the active pharmaceutical ingredient (chemicals) in these approved products. These chemicals are identified by registry numbers (i.e. CAS numbers). The CAS number for USP grade activated charcoal is 7440-44-0.
Powdered activated charcoal, sold by chemical companies, that has a CAS number of 7440-44-0, with the specification that it meets USP testing standards, could be considered as a substitute for aqueous activated charcoal until such time as the aqueous products are no longer on back order. Poison Centres are not able to endorse any particular product.
Preparation would require accurate measurement of 50 g of powdered activated charcoal by weight, suspended in 250 mL of water. For pediatric patients, 25 g of powdered activated charcoal could be suspended in 125 mL of water.
Some pharmacies have chosen to place the powder in the appropriately sized container made available to emergency departments and to have the container filled and shaken at the bedside at the time of dispensing. Others have chosen to have these pre-made in the pharmacy.
As always, consultation with your provincial poison centre regarding individual patient decisions around the use of activated charcoal for decontamination is recommended, especially in this time of its reduced availability.
Margaret Thompson, MD, FRCPC
Medical Director, Ontario & Manitoba Poison Centre
N.B.: The Centre antipoison du Québec is in agreement with this letter from the Ontario & Manitoba Poison Centre.