One dose of activated charcoal is usually sufficient to achieve a therapeutic effect. Multiple-dose activated charcoal, however, should be administered in specific instances, such as after ingestion of very large doses, substances that form bezoars in the GI tract, potentially injurious toxins that slow gut function, or toxins that are released slowly into the gut lumen. Multiple-dose activated charcoal is usually given as follows: the first dose is up to 1 g/kg body weight, which is then followed by subsequent doses of 0.25 to 0.50 g/kg. Repeated doses of activated charcoal should be given in an interval ranging from 1 to 4 h. To prevent excessive fluid loss and electrolyte imbalance, only the first dose of activated charcoal should be given with a cathartic.
Multiple-dose activated charcoal is contraindicated in patients who have decreased gut motility, because the risks of the procedure include aspiration from gastric distention, and impaction of charcoal within the gut. The benefits of multiple-dose activated charcoal include achievement of a 10:1 activated charcoal to drug ratio in patients with very large ingestions and the binding of drugs within the gut lumen after ingestion of substances that have a large enterohepatic or enteroenteric circulation. Patients having ingested life-threatening toxins who have decreased gut motility can receive multiple doses, but the stomach must be suctioned just prior to the administration of the next dose of activated charcoal to minimize distention.
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