Activated Charcoal Administration in Paracetamol Poisoning

Timing and Dosing

• Activated charcoal should be administered at 1 g/kg orally (standard adult dose 50g) if the patient presents within 1-2 hours of paracetamol ingestion, and it can still provide benefit up to 3-4 hours post-ingestion 1
• Extended benefit window: Activated charcoal can still be beneficial up to 3-4 hours after ingestion 1
• Standard dosing: 1 g/kg body weight as a slurry in water (50g for adults) 1

Critical Clinical Considerations

• Activated charcoal administration does NOT interfere with subsequent N-acetylcysteine (NAC) therapy, so do not delay NAC if charcoal was just given 1
• NAC remains the definitive antidote and should be started based on standard nomogram criteria regardless of charcoal administration 1

Contraindications and Safety

• Activated charcoal should NOT be given when there is active gastrointestinal bleeding present 2
• Activated charcoal should NOT be given when there is a risk of gastrointestinal perforation exists 2

Formulation Cautions

• Use sorbitol-containing formulations cautiously, as hypernatremic dehydration has been reported with repeated doses 3, 2, 4
• Administer activated charcoal as a slurry in water 2