Typically, activated charcoal is administered with an osmotic cathartic, such as a 70% sorbitol solution (1 g/kg), or a 10% solution of magnesium citrate (in a dose of 250 mL for adults and 4 mL/kg for children). Cathartics have been repeatedly shown to decrease the transit time for the passage of the activated charcoal (and presumably the adsorbed toxin) through the GI tract. 9,10 Although most studies fail to show a benefit of administering a cathartic alone,1 l2 several studies suggest that there is a decrease in peak serum plasma concentrations, and area under the curve when the cathartic is administered with activated charcoal. 1 l4 No definitive clinical human data, however, suggest that the addition of a cathartic to a dose of activated charcoal either limits the toxin's bioavailability or changes the patient's clinical outcome.

Indications for use of cathartics generally mirror those for the administration of activated charcoal. When multiple-dose activated charcoal is used, only the first dose is accompanied by a cathartic, to limit complications. Complications of cathartic administration include nausea and abdominal pain, severe volume depletion, electrolyte imbalances and fluid shifts, and hypermagnesemia in patients with renal compromise.

Contraindications for cathartic use are, after an ingestion of a substance that will result in diarrhea, children younger than age 5, patients with renal failure (only magnesium-containing cathartics are contraindicated), intestinal obstruction, or an ingestion of any caustic material.

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