Alginate-coated activated charcoal enhances fecal excretion of 2,3,7,8-tetrachlorodibenzo-p-dioxin in mice, with fewer side effects than uncoated one.

Activated charcoal (AC) is a potential candidate antidote against dioxins. However, it is difficult to take AC as a supplement on a daily basis, because its long-term ingestion causes side effects such as constipation and deficiency of fat-soluble essential nutrients and hypocholesterolemia. Alginate-coated AC, termed Health Carbon (HC), was developed to decrease the side effects of AC, but its pharmacological effects, including side effects, remains unclear. Here, we show that HC enhanced fecal excretion of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and decreased some side effects of unmodified AC, such as hypocholesterolemia, in male mice. Basal diet mixed with HC or unmodified AC at various concentrations was fed to mice for 16 days following a single intraperitoneal administration of [3H]TCDD. Both HC and unmodified AC at 3% or more significantly increased fecal excretion of [3H]TCDD in comparison with the control basal diet. Consistent with this, [3H]TCDD radioactivity in the liver-a major TCDD storage organ-was markedly decreased by HC at concentrations of 3% and 10%. In an examination of potential side effects, unmodified AC at 10% or more caused significant body weight reduction and at 20% caused significant hypocholesterolemia. In contrast, HC caused weight gain reduction only at a concentration of 20%, and there was no evidence of hypocholesterolemia at any dietary HC concentration. HC not only retains the ability of AC to enhance fecal excretion of TCDD but also reduces some of the side effects of AC.

Intestinal Chelators, Sorbants, and Gut-Derived Uremic Toxins.

Chronic kidney disease (CKD) is a highly prevalent condition and is associated with a high comorbidity burden, polymedication, and a high mortality rate. A number of conventional and nonconventional risk factors for comorbidities and mortality in CKD have been identified. Among the nonconventional risk factors, uremic toxins are valuable therapeutic targets. The fact that some uremic toxins are gut-derived suggests that intestinal chelators might have a therapeutic effect. The phosphate binders used to prevent hyperphosphatemia in hemodialysis patients act by complexing inorganic phosphate in the gastrointestinal tract but might conceivably have a nonspecific action on gut-derived uremic toxins. Since phosphorous is a major nutrient for the survival and reproduction of bacteria, changes in its intestinal concentration may impact the gut microbiota's activity and composition. Furthermore, AST-120 is an orally administered activated charcoal adsorbent that is widely used in Asian countries to specifically decrease uremic toxin levels. In this narrative review, we examine the latest data on the use of oral nonspecific and specific intestinal chelators to reduce levels of gut-derived uremic toxins.

Charcoal and charcoal-based dentifrices: A literature review.

BACKGROUND: Sales of charcoal dentifrices and powders have rapidly emerged into the Internet marketplace. The authors conducted a literature review to examine the efficacy and safety of charcoal and charcoal-based dentifrices. METHODS: The authors searched the MEDLINE and Scopus databases for clinical studies on the use of charcoal and charcoal-based dentifrices and laboratory investigations on the bioactivity or toxicity of charcoal and charcoal-based dentifrices, published through February 2017. The authors used a defined search strategy to identify randomized, controlled clinical trials with a follow-up duration of 3 months or longer. In addition, the authors selected the first 50 consecutive charcoal dentifrices from Google.com and Amazon.com for ascertainment of product assortment and advertising promotions. RESULTS: The authors' literature search identified 118 potentially eligible articles. Thirteen studies reported brushing the teeth with raw charcoal or soot; however, none of these studies met the inclusion criteria. Two studies offered nonspecific caries reductions, 3 studies reported deleterious outcomes (increased caries, enamel abrasion, nonquantified negative impact), and 1 study indicated only that brushing with raw charcoal had no adverse effects on oral hygiene. Seven other studies reported only on the use of charcoal for oral hygiene. Internet advertisements included unsubstantiated therapeutic claims-such as antibacterial, antifungal, antiviral, and oral detoxification, as well as potentially misleading product assertions. One-third of the charcoal dentifrices contained bentonite clay, and 1 contained betel leaves. CONCLUSIONS: The results of this literature review showed insufficient clinical and laboratory data to substantiate the safety and efficacy claims of charcoal and charcoal-based dentifrices. Larger-scale and well-designed studies are needed to establish conclusive evidence. PRACTICAL IMPLICATIONS: Dental clinicians should advise their patients to be cautious when using charcoal and charcoal-based dentifrices with unproven claims of efficacy and safety.

Metabolic acidosis during treatment of mushroom poisoning: a diagnostic pitfall.

Metabolic acidosis is a frequently encountered acid-base disturbance in hospitalized patients that occasionally develops in the course of treatment with medications used in everyday clinical practice, including propylene glycol-containing drugs (lorazepam, diazepam, etomidate, pentobarbital). Disruption of enterohepatic circulation with activated charcoal is a common practice for several intoxications, including mushroom poisoning. Herein, we present a patient who was hospitalized due to mushroom intoxication and developed severe metabolic acidosis as a treatment side effect rather than from the mushroom poisoning. To the best of our knowledge, this is the first report on propylene glycol-containing activated charcoal-induced metabolic acidosis.

Pseudomelanosis ilei associated with ingestion of charcoal: case report and review of literature.

Melanosis or pseudomelanosis of the gastrointestinal tract refers to an accumulation of pigment deposits in the gastrointestinal mucosa. Pigmentation can affect the entire gastrointestinal tract. Melanosis of the colon is not uncommon, but black pigmentation of the small intestine is extremely rare. We report a case of pseudomelanosis of the terminal ileum in a 52-year-old woman who had ingested a tablespoon of charcoal powder daily for 2 years. Numerous small and medium-sized irregular grayish black pigmentations mostly on the background of geographic light grayish discolored mucosa and some on the normal-looking mucosa were seen on the terminal ileum. The finding was similar to a cut surface of a dragon fruit and we named the lesion 'dragon fruit ileum'. Follow up endoscopy 10 months later revealed no significant change in the pigmentation. We could not search any English literature on this lesion. However, we could find three cases from two papers from Korea describing similar lesions after chronic charcoal ingestion and the papers were reviewed with a report of our case.

Tattooing breast cancers treated with neoadjuvant chemotherapy.

BACKGROUND: In breast carcinomas treated with neoadjuvant chemotherapy, intraoperative identification of residual tumors may be difficult. A well-tolerated, low-diffusion charcoal suspension has been designed to tattoo breast tumors. In this study, we investigated whether this tattooing technique is efficient for localizing the tumor after treatment with chemotherapy. METHODS: In a series of 109 patients with large breast tumors, a 4% or 10% charcoal suspension was injected at the time of the initial biopsy before preoperative chemotherapy. RESULTS: Tolerance was good. After three or four cycles of chemotherapy, 91 patients underwent conservative treatment, and the surgical specimen was examined intraoperatively. The charcoal was detected in 94% of the cases. The charcoal was seen in the nodule or at the periphery in the surgical specimen without any acute inflammatory reaction or diffusion. CONCLUSIONS: On the basis of these results, this micronized charcoal suspension at a defined granulometry and a concentration of 10% seems to be ideal for tattooing breast carcinomas over a period of 3 months in patients in whom neoadjuvant chemotherapy is planned.

Pediatric toxicology.

Pediatric patients present unique concerns in the field of medical toxicology. First, there are medicines that are potentially dangerous to small children, even when they are exposed to very small amounts. Clinicians should be wary of these drugs even when young patients present with accidental ingestions of apparently insignificant amounts. Next, over-the-counter laxatives and syrup of ipecac, although not commonly considered abused substances, may be misused in both the setting of Munchausen's syndrome by proxy and in adolescents who have eating disorders. Their use should be considered in any gastrointestinal illness of uncertain origin. Finally, as the use of syrup of ipecac at home now has been discouraged by many, some have explored using activated charcoal at home as a new method of prehospital gastrointestinal decontamination. The literature examining activated charcoal and its use in this capacity is discussed.

Acupressure for prevention of emesis in patients receiving activated charcoal.

OBJECTIVE: Vomiting after activated charcoal decontamination is problematic. Acupressure (traditional Chinese medicine) is an effective treatment for emesis, but has not been tested in overdose patients. We sought to determine (1) the incidence of emesis after activated charcoal and (2) the ability of acupressure to prevent emesis due to activated charcoal. METHODS: Consecutive overdose patients were enrolled in a preliminary, prospective study to determine the incidence of emesis after activated charcoal. Awake patients, > 18 years, received 1 g/kg activated charcoal orally or via nasogastric tube, and then observedfor 1 hour. These patients served as controls forpart 2 of the study, where acupressure bands were placed on overdose patients at the Nei-Guan P-6 point of both wrists prior to activated charcoal, followed by 1 hour observation. Exclusion criteria included: ipecac decontamination, antiemetic drug ingestion, antiemetic drug therapy within 1 hour of activated charcoal, or intubation. RESULTS: Eighty-one patients were included in the control group and 106 patients in the acupressure treatment group. Demographics and ingested substances were similar in both groups. 21/81 (25.9%) in the control group vomited and 15/106 (14.2%) in the acupressure group vomited. Acupressure reduced emesis by 46% (p = 0.043; chi2). Within the acupressure group, the median duration of prophylactic acupressure was 5 minutes in those patients without vomiting compared to 4 minutes in those patients with vomiting (NS; Wilcoxon rank sum test). CONCLUSION: The incidence of emesis after activated charcoal at our institution was 26%. Prophylactic acupressure reduced activated charcoal-induced vomiting by 46%. Investigators suggest 5 minutes of acupressure prior to activated charcoal.

Hydrocarbon emissions and health risks from cookstoves in developing countries.

The nonmethane hydrocarbon emissions from several types of cookstoves commonly used in developing countries were measured in a pilot study conducted in Manila, the Philippines. Four types of fuel, i.e., wood, charcoal, kerosene, and liquefied petroleum gas (LPG), were tested. Because kerosene was burned in three different types of stoves, there were six fuel/stove combinations tested. Fifty-nine nonmethane hydrocarbons were identified frequently in emissions of these cookstoves, with emission ratios to CO2 up to 5.3 x 10(-3). The emissions were quantitated with emission factors on both a mass basis (emissions/kg fuel) and a task basis (emissions/cooking task). On a task basis, combustion of biomass fuels (wood and charcoal) generally produced higher emission factors than combustion of fossil fuels (kerosene and LPG). One type of kerosene stove (wick stove), however, still generated the greatest emissions of some individual and classes of hydrocarbons, indicating that emissions were dependent on not only fuel types but also combustion devices. Some hydrocarbons, e.g., benzene, 1,3-butadiene, styrene, and xylenes, were of concern because of their carcinogenic properties. The lifetime risk from exposures to these compounds emitted from cookstoves was tentatively estimated by using a simple exposure model and published cancer potencies.

Manejo inicial de intoxicaciones con jarabe ipeca, carbón activado y diálisis enteral / First management of ipeca syrup intoxication, active carbon and enteral dyalisis

Ya en el siglo XVI Paracelso escribió: cualquier sustancia puede ser tóxica y todo depende de la dosis administrada. La intoxicaciones son un motivo frecuente de consulta, el 82 por ciento de ellas se producen vía digestiva, el 70 por ciento del total son de tal gravedad, que requieren hospitalización y de éstas la mitad debe hacerlo en Unidades de Cuidados Intensivos

Carbon monoxide poisoning from indoor burning of charcoal briquets.

OBJECTIVE: To describe the case characteristics of a series of patients poisoned with carbon monoxide (CO) resulting from indoor burning of charcoal briquets. DESIGN: Cases of patients with unintentional CO poisoning referred for treatment with hyperbaric oxygen were reviewed. Cases that occurred as the result of indoor burning of charcoal briquets were analyzed. SETTING: A private, urban, tertiary care center. PATIENTS: Seventy-nine patients ranging from 3 months to 87 years of age referred from 10 counties within the state of Washington between October 1982 and October 1993. RESULTS: Of 509 patients treated for acute unintentional CO poisoning, 79 cases occurred in 32 incidents as a result of indoor burning of charcoal briquets, for the purpose of either home heating or cooking. A majority of cases occurred in the months of October through January, commonly during power outages or when electricity was intentionally disconnected. Patients of minority races were disproportionately represented compared with the general population of the region. CONCLUSIONS: Carbon monoxide poisoning is a significant hazard from indoor use of charcoal briquets. All cases are avoidable and public awareness of the risk should be enhanced.

Pediatric gastrointestinal decontamination in acute toxin ingestion.

The appropriate implementation of the various modalities of gastrointestinal (GI) decontamination is critical in the management of the pediatric patient who is examined in the emergency department or private office after an acute ingestion. Gastrointestinal decontamination includes gastric lavage, syrup of ipecac, activated charcoal, and whole bowel irrigation. Clinical studies have delineated the role and efficacy of these procedures. Trends in GI decontamination place less emphasis on ipecac and gastric lavage and more emphasis on activated charcoal alone in the patient with a mild overdose. Gastric lavage is indicated in serious ingestion and is most effective if done soon after the exposure. Whole bowel irrigation is the newest addition and has important clinical use in the treatment of serious iron ingestions as well as in older adolescent cocaine body suffers and packers. Indications and contraindications of the various forms of GI decontamination are discussed and relevant clinical studies are reviewed.

Treatment of neonatal hyperbilirubinemia with repetitive oral activated charcoal as an adjunct to phototherapy.

The efficacy of multiple dose oral activated charcoal (OAC) therapy for neonatal hyperbilirubinemia was prospectively studied in 30 jaundiced newborns receiving phototherapy, randomly assigned to a study group (n = 14) or control group (n = 16). The study group received OAC before meals with a total amount of 8.5 +/- 0.85 gms (M +/- SEM). Serum bilirubin levels upon initiation of phototherapy were (M +/- SEM) 265 +/- 8 and 253 +/- 4 mumol/L respectively. After 24 hours there was no significant decrease in serum bilirubin levels in the control group (M +/- SEM = 240 +/- 8 mumol/L) but bilirubin levels of the study group decreased (M +/- SEM = 235 +/- 7 mumol/L, p < 0.02). At 48 hours serum bilirubin levels were significantly lower than baseline values in both groups. However, the decline in bilirubin levels in the study group (M +/- SEM = 56 +/- 10 mumol/L) was greater than that of the controls (M +/- SEM = 21 +/- 10 mumol/L p < 0.02). Oral activated charcoal seems to be an effective adjunct to phototherapy in the treatment of neonatal hyperbilirubinemia.

Intestinal pseudo-obstruction following the use of enteral charcoal and sorbitol and mechanical ventilation with papaveretum sedation for theophylline poisoning.

We report 2 cases of intestinal pseudo-obstruction, 1 fatal, which developed following the use of enteral activated charcoal with sorbitol, and mechanical ventilation with papaveretum ('Omnopon') sedation for the treatment of severe theophylline self-poisoning. While mechanical intestinal obstruction may rarely complicate the use of enteral activated charcoal, pseudo-obstruction has not been previously described. Causal mechanisms and prophylaxis are discussed, highlighting a possible interaction between theophylline and papaveretum, and the dangers of multidose enteral charcoal with sorbitol in this context.

Pneumoconiose em trabalhadores de industria de abrasivos / Pneumoconiosis in workers of abrasive industry

O desenvolvimento de pneumopatia profissional em operarios de industrias de material abrasivo e incomun, sendo ate recentemente considerada a silica como causadora da pneumoconiose. Analisamos 22 operarios destas industrias em que se detectaram alteracoes radiograficas de torax. Todos eram do sexo masculino, com idades variando de 29 a 59 anos. Dezenove trabalhavam na producao de carbeto de silicio, tres na producao de oxido de aluminio e um em ambos, tendo ficado expostos por um periodo de 8 a 27 anos. As alteracoes radiologicas (ILO-80) predominantes foram pequenas opacidades em 20 pacientes. Associacao de grandes e pequenas opacidades foram observadas em um caso e grandes opacidades isoladamente em um. As pequenas opacidades foram predominantemente difusas e arredondadas. Nos dois doentes com grandes opacidades, estas se enquadravam como categoria B. Conclui-se que operarios em industrias de abrasivos encontram-se sob risco de desenvolvimento de pneumopatia profissional mais provavelmente desencadeada pela inalacao de carbeto de silicio.

Dental abrasion pattern in a selected group of Malaysians.

Among 350 inhabitants of two villages, 31 (8.9%) cleaned their teeth using table salt and charcoal applied to their forefinger or a Melastoma brush. As a result, all had distinct forms of abrasion cavity on the labial surfaces of their teeth. All of the above three agents are highly abrasive and injurious to both the hard and soft oral tissues. This dying practice is only popular among a very small number of persons in the older age group, and should be discouraged.

Gastrointestinal decontamination for acute poisoning.

Gastric decontamination remains an important element in the therapy of pediatric poisoning; however, several issues remain unresolved. Additional studies, particularly in the clinical setting, are necessary to establish optimal therapeutic recommendations. Based on the data presented in this review, the following general recommendations can be made for gastric decontamination in children: If it is necessary to remove an ingested toxin, ipecac syrup is the preferred method if contraindications to its use are not present. The dose should be 30 ml in children older than 1 year of age and 10 ml in children 6 to 12 months of age. Pending further studies, the use of emetics in children younger than 6 months of age cannot be generally recommended, particularly in the home setting. Gastric lavage should be considered to be of very limited use in pediatric patients. Lavage using small nasogastric tubes, except under special circumstances, is nonproductive and cannot be advocated. If it must be used, a large-bore orogastric hose should be used. Administration of activated charcoal prior to lavage should be considered. In situations in which prompt induction of emesis is not possible or contraindications to emesis exist, activated charcoal followed by, or mixed with, a cathartic (preferably sorbitol) should be used as an alternative to removal of gastric contents. Patients with significant symptoms from ingestion requiring hospitalization should receive repeat doses of charcoal and cathartic until symptoms resolve. Activated charcoal should be given in conjunction with other appropriate therapies. Although the data to substantiate this recommendation are limited, particularly in pediatric patients, it is a benign therapy that holds promise of increasing drug elimination.