(CHAR-kole)
Actidose-Aqua, Actidose with Sorbitol, Charcoaid, Charcoaid 2000, Liqui-Char,  Charcodote
Class: Antidote

 Action Inhibits GI absorption.

 Indications Emergency treatment of poisoning by most drugs and chemicals. Unlabeled use(s): Treatment of diarrhea, stomach gas and excessive flatulence.

 Contraindications None known. Ineffective for poisonings by cyanide, mineral acids and alkalis. Not particularly effective for poisonings by ethanol, methanol and iron salts.

 Route/Dosage

Acute Intoxication

Po/Gavage tube 30–100 g (or 1 g/kg or approximately 5–10 times amount of poison ingested) as suspension (mixed with 6–8 oz water).

GI Dialysis

Po/Gavage tube 20–40 q 6 hr for 1–2 days; alternate aqueous suspension and sorbitol suspension.

 Interactions

Food (milk, ice cream and sherbet): Decrease the absorptive capacity of drug. Other medications: May have decreased effectiveness due to absorption by activated charcoal (eg, oral acetylcysteine used as antidote for acetaminophen overdose). Syrup of ipecac: Inactivated due to absorption by activated charcoal. Do not administer together.

 Lab Test Interferences None well documented.

 Adverse Reactions

GI: Vomiting; constipation or diarrhea; black stools. Sorbitol may cause loose stools and vomiting.

 Precautions

Pregnancy: Pregnancy category undetermined. Lactation: Undetermined. Children: Use under physician’s supervision so fluid and electrolyte balance can be monitored properly.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • When inducing vomiting, do so before giving activated charcoal. When large doses of drugs have been ingested, remove as much of ingested poison as possible by gastric lavage.
  • Note that patient may be intolerant of activated charcoal for 1–2 hr after ipecac-induced vomiting.
  • Administer orally to conscious patients only.
  • For comatose patients or patients with altered mental status, administer via nasogastric tube.
  • Mix 30–100 g as a slurry with 6–8 oz water or use premixed solution with 12.5–50 g in sorbitol suspension.
  • In acute poisoning, administer as soon as possible. Drug is most effective when given within 30 min of poisoning.
  • Store in tightly closed container. Premixed suspension can be stored for up to 1 yr.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies, and note which medications were ingested and amounts ingested, if syrup of ipecac was given and if ingested material was acidic.
  • Obtain a toxicology screen of urine and serum.
  • Assess and monitor vital signs and neurologic signs.
  • Assess mental status and LOC.
  • Monitor airway, ECG and I&O.
  • Observe for vomiting or diarrhea.
  • Keep patient well hydrated.

 Patient/Family Education

  • This drug should not be used as antidote in home.
  • Advise patient that stools will be black for several days.
  • Advise patient that diarrhea may continue for 24–48 hr.

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