Multiple doses of activated charcoal are indicated when the toxicant is a delayed release product, if it undergoes enterohepatic recirculation, or if it has a particularly long half-life e.
Activated charcoal administration is contraindicated for a patient that is already exhibiting clinical signs e. Another contraindication for administration of activated charcoal is when it does not bind to the toxicant e. For example, activated charcoal administration is not indicated for toxicants such as ethanol, ethylene glycol, xylitol, heavy metals e.
Some of the most common complications resulting from the administration of activated charcoal are vomiting, hypernatremia, and aspiration pneumonia. The concurrent administration of a parenteral antiemetic e.
Patients receiving activated charcoal with or without a cathartic should be monitored for rare adverse effects. Clinical signs of hypernatremia are similar to those of certain toxicoses e. Patients demonstrating these clinical signs, receiving multiple doses of activated charcoal, or potentially predisposed to these adverse effects e. The use of activated charcoal in the decontamination of a poisoned animal continues to have an important role. However, veterinarians should be aware of the appropriate indications, specific dosing, contraindications, and rare adverse effects seen with the administration of activated charcoal and cathartics.
Before beginning activated charcoal administration, it is always important to determine that the overall benefit of decontamination outweighs the risks. Position paper: cathartics. Clin Tox ;42 3 Lee JA. Complications and controversies of decontamination: activated charcoal—to use or not to use, in Proceedings. Howland MA. Antidotes in depth: activated charcoal. Goldfrank's toxicologic emergencies. Your veterinarian may also recommend additional treatments, such as IV fluids and medications for nausea and vomiting, to manage the side effects of activated charcoal.
Potential side effects of activated charcoal in dogs include:. Activated charcoal binds to many common medications and may reduce their efficacy. Let your veterinarian know if your dog has taken any oral medications in the past 24 hours. Careful dosing is especially important if the product contains cathartic agents such as sorbitol, because this can lead to dehydration and electrolyte imbalances if administered incorrectly.
Some toxins may require multiple administrations of activated charcoal for best results. Consult your veterinarian or poison control prior to administering any activated charcoal to your dog. Activated charcoal is a relatively inexpensive product. Other medications may also need to be prescribed in order to address the toxicity and manage the side effects of activated charcoal, so this may increase the overall cost of treatment.
There are reports of corneal abrasions as a result of direct contact. With repeated dosing, constipation can occur. Another important potential complication is hypernatremia. This is seen in young animals, animals receiving multiple doses, and with cathartics. AC results in osmotic fluid shifts into the intestinal tract.
Patients with increased free water loss and those that are severely dehydrated are also more prone to the development of hypernatremia. Ideally, hydration status should be evaluated before administration of AC. To help avoid development of hypernatremia, patients can be placed on IV fluids, especially if they are dehydrated. In summary, the risks and benefits of AC administration should be considered for each individual case.
As it is an inexpensive treatment with few complications, it is frequently appropriate to use in cases of known and unknown toxin ingestion. American Academy of Clinical Toxicology. Position statement: single-dose activated charcoal. Clin Tox ; 35 7 : Position statement and practice guidelines on the use of multi-dose activated charcoal in the treatment of acute poisoning. Clin Tox ; 37 6 : Ball A. Toxicology case: managing hypernatremia after activated charcoal administration.
Vet Med, Lapus RM. Activated charcoal for pediatric poisonings: the universal antidote? How much does it weigh? Find out this general triage information to be sure that adequate measures can be taken for stabilization and treatment. Once animal is stable, a more thorough medical history should be obtained including complete medical background of the animal, exact toxicant information including brand name, generic name especially if it is a medication , and active ingredients. A more complete history of the exposure should also be obtained including exposure time, amount of toxicant the animal was exposed to, and by what route was the animal exposed orally, dermally, etc.
Ideally, a support staff member could be taking the history from the owner and phoning the APCC as soon as possible while the animal is being treated.
Be prepared to intubate the animal upon presentation. Not only will this secure an airway, but also it will help prevent aspiration in the event that gastric lavage is necessary. This may or may not be necessary in every case, but preparation is the key.
Have oxygen and an AMBU bag standing by in case they are needed. It is best to try to insert an I. Once the catheter is placed, draw blood at least one 3cc EDTA tube and two serum tubes are ideal for any diagnostic tests to be performed later. If possible these samples should be taken before any other meds are administered. Monitor the animal for any cardiovascular abnormality. Atropine at a dose of 0.
Plumb, 3rd. Propranolol is the drug of choice for treating tachycardia, administered slow I. These drugs as well as detailed protocols for their administration in case a veterinarian is not readily available should be easily accessible in a crash cart. Control seizures. If an animal is seizing when it presents, controlling the seizures is a top priority. It may be necessary to mask an animal down to get the seizures under control.
Specific doses of these drugs are going to very depending on the agent involved. What that method is depends greatly on the agent involved and the condition of the animal at presentation. We will go into great detail about this later in the presentation. Antivenins or antitoxins should be administered at this point. Keep in mind that in more cases than not, there is NO specific antidote.
Preventive measures such as gastric protection or antibiotics may be needed. Administer the proper fluids to correct acid base balance, hydration, and electrolyte imbalances.
The two most commonly used fluids are Lactated Ringers Solution and normal saline due to their versatility and availability. Intravenous is the preferred route of administration of fluids, due to the speed of delivery. Ancillary procedures should be performed to prevent damage from the toxicant. The systems that are most likely affected by the toxicant should be monitored. Complete serum chemistry panels, coagulation panels, or diagnostic tests may be needed.
Appropriate supportive care should be given until the animal completely recovers. A large syringe 60 cc is ideal for flushing eyes. Always remember to flush eyes from the inner corner out so contamination of the opposing eye does not occur. After flushing, the eyes should be treated with lubricant ointments not medicated and examined for corneal damage.
The eyes should be monitored for excessive redness, lacrimation, or pain. Follow up examinations may be needed to establish level of corneal damage. Baths may need to be repeated to completely remove the toxicant.
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