Blog - Liquid, gel, powder or tablets? What type of activated charcoal product is best for my poisoned patient?!
Activated charcoal preparations -what’s the difference?
With many activated charcoal products available; gels, liquids, tablets and powders, it can sometimes be challenging to know how they compare and which is best to recommend in cases of intoxication.
Powders are time consuming and messy to prepare. It can be difficult to know how much water to add to make them into an appropriate consistency. This can ultimately reduce owner compliance, particularly in cases where repeat administration is required.
Tablets may not distribute evenly through the gastrointestinal tract, therefore limiting contact with toxins resulting in reduced toxin adsorption and thus greater availability for toxin absorption into the systemic circulation. It is also difficult to establish how much activated charcoal is present in a tablet, although generally they contain 0.25-0.3g of activated charcoal per tablet. To provide the recommended amount of activated charcoal (1g/kg), a 20kg dog would require 80 tablets per administration!
Liquids are a great option for activated charcoal because they coat the gut wall and provide a large surface area for toxin adsorption. Available liquid formulations vary in their adsorbency and some are known to sediment over time, particularly when presented in large bottles, rendering attempts to resuspend the formulations ineffective. This results in a diminished concentration of activated charcoal within the remaining liquid part, thereby reducing the adsorbency potential or ability to accurately calculate how much activated charcoal is being administered.
Carbodote® liquid offers a stable, homogenous, 20% activated charcoal solution in manageable bottles of 100ml. To administer the recommended 1g/kg of activated charcoal, 5mls of Carbodote® liquid per kg is required, making calculating the appropriate volume of activated charcoal for the patient quick and simple.
Gel formulations of activated charcoal are now available with Carbodote Prime® and Carbodote Repeat®.
Carbodote Prime® includes a cathartic (sodium sulphate) and activated charcoal, indicated for the first administration following toxin ingestion, to expedite toxin elimination. Carbodote Repeat® contains plain activated charcoal for situations where repeated administrations of activated charcoal are required.
The gels come in ‘dial and dispense’ syringes, making calculating the amount to administer quick and straight forward, as well as providing a familiar and easy to use delivery mechanism.
What are the advantages of the Carbodote® gels?
- More concentrated (30%) – less volume to administer
- Less messy -no liquid to be spilt!
- Easier to swallow -reduced aspiration risk, improved compliance
- Carbodote Prime® is pre-mixed with a cathartic -no need to administer separately!
To find out more about activated charcoal and when to use it, please visit our previous blog post: What is activated charcoal and when should I be using it?
Carbodote® products contain super-activated charcoal, which means they offer superior adsorbancy -up to 4.5 x more adsorbant than competitors*
Frequently asked questions…
It is generally recommended to try to administer activated charcoal at least 3 hours before or after food so that the adsorbancy potential is not compromised. One in-vitro study found that whilst the total adsorptive capacity of activated charcoal is reduced by the addition of dog food, this was not likely to result in clinical significance within an in-clinic situation.
Carbodote® products offer superior adsorbancy* therefore it is unlikely that administration with a small amount of food to aid consumption will affect its toxin binding potential.
In the literature, the amounts of activated charcoal to be administered range from 1-4g/kg. The volumes of the Carbodote® products equates to 1g/kg. This recommendation is based on the scientific literature. Administration of a greater quantity can be achieved by administering a larger volume of Carbodote® although due to Carbodote® products’ superior adsorbancy* it is unlikely that administration >1g/kg is required.
Note: 1g/kg of activated charcoal equates to 5ml of Carbodote® liquid and 3mls of Carbodote Prime® or Carbodote Repeat®. The gel formulations work on a dot system, where 1 dot should be administered per 2kg.
For the first administration of activated charcoal following toxin ingestion, it is recommended to co-administer a cathartic. This is to speed up the elimination of the toxin (bound to activated charcoal) from the gastrointestinal tract, thereby reducing the opportunity for any toxin to be absorbed into the systemic circulation.
Carbodote Prime® contains sodium sulphate, which is an effective osmotic cathartic that is not known to interact with any toxins and is well tolerated.
Cathartic administration should not be repeated as it can result in dehydration and electrolyte disturbances, therefore, when repeat administration of activated charcoal is required, plain activated charcoal, such as Carbodote Repeat® should be used.
Some toxins will persist in the gastrointestinal tract and therefore repeat administration of plain activated charcoal, such as Carbodote Repeat® every 4-6 hours for 24-48 hours is recommended.
Repeat administration is required for toxins that are/have;
- Enterohepatic recirculation
- Sustained release formulations (some human medications)
- Long gastrointestinal residency times (e.g., grapes)
- Low affinity for activated charcoal (repeat administration maximises toxin absorption)
- Potential for the toxin to be adsorbed out of the circulation into the intestinal lumen (entero-enteric recirculation).
Check out our handy guide to find out which toxins require repeat administration!
You can find out more information on Carbodote, the Anti-Tox range and all of our resources, including our 14 poison guidelines here.
* Study C14-2017/DPh
