The Role of Activated Charcoal in Prehospital Care.

Background: Administration of a single-dose activated charcoal (SDAC) is an effective method used for gastric decontamination and for other types of poisoning and overdose. This is only true when given within the first hour of poison ingestion as the effectivity of SDAC reduces over time. In addition, generally, not all patients are able to avail treatment within the specified period. Hence, multi-dose activated charcoal is regarded as a solution to a delayed process, although, no proof outweighs the use of SDAC. Objective: This study aimed to review and assess the adequacy of the past and current use of AC. The author also aimed to offer recommendations believed to be the best method to consider for prehospital care. Methods: The author conducted 6,337 online literature searches for this review, wherein seven papers met eligibility criteria for inclusion and analysis. Results: In this review, routine administration of AC in poisoning was found not related to the duration of hospital stay nor any other subsequent outcomes following poison ingestion. Further, this review did not establish that administration of AC could improve patient's clinical outcome. Further research and clinical trials is required to determine the efficacy of this therapy to appropriate patients in the prehospital setting. Conclusion: Activated charcoal can be used to treat highly acute to life-threatening poisoning if it is administered within the first hour of ingestion. Further studies would be necessary to investigate if this would affect clinical outcome..

Relative dentin and enamel abrasivity of charcoal toothpastes.

OBJECTIVES: Very little data are known about charcoal toothpastes. The aim of this study was to counteract the missing data by determining the relative dentin abrasivity (RDA) and relative enamel abrasivity (REA) values of charcoal toothpastes. METHODS: Radioactively charged dentin and enamel samples were randomly divided into groups of eight specimens. Each group was brushed with two of total 12 charcoal toothpaste slurries and with a standard abrasive with a known RDA and REA value. The measured radioactivity in counts per minute within the slurries corresponds to the amount of dentin or enamel abraded. RDA and REA values of the charcoal toothpastes were expressed relative to the known value of the standard slurry. RESULTS: The RDA and REA values of the charcoal toothpastes have a broad range of 24-166 and 0-14, respectively. CONCLUSIONS: The RDA and REA values do not differ significantly from previously tested commercially available toothpastes. However, the lack of fluoride compounds in many of the investigated charcoal toothpastes can have a less beneficial effect for the consumers. It is very important to educate patients accordingly.

The evolution of charcoal-burning suicide: A systematic scoping review.

INTRODUCTION: Suicide by charcoal burning has accounted for more than 100,000 deaths. It has become an increasingly common suicide method in Hong Kong since first reported in 1998, and it has spread into South Korea, Taiwan, Japan and other countries. This systematic scoping review aimed to explore current evidence on trends, risk factors, impact of media and prevention strategies for this suicide method, and to identify research gaps. METHODS: A search for articles published from January 1998 to June 2021 was conducted through electronic databases (MEDLINE, EMBASE, SCOPUS and PsycINFO) with the keywords (suicide*) AND (charcoal). Articles describing prevalence, trends, characteristics, risk factors and prevention strategies of charcoal burning suicide deaths were included. Non-peer-reviewed articles, non-English articles, commentaries/editorials/letters, poster abstracts, reviews, meta-analyses and studies that documented only charcoal burning suicide attempters/survivors were excluded. RESULTS: Eighty-eight studies were identified, most from East Asia. Charcoal burning suicide rates in Hong Kong, Taiwan and Japan has passed the peak, while continuing to increase in South Korea. Risk factors are changing and not static. Media appears to play an important role in triggering and spreading information. Restricting access to charcoal, and raising public awareness have been effective in the short term in preventing charcoal burning suicide, but there is little information on their long-term effectiveness or sustainability. DISCUSSION: More research is required to update the development and dynamic changes of charcoal burning suicide and the contributing factors. The evidence from this review may assist in detecting and intervening early for future novel suicide methods.

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.

Polycyclic Aromatic Hydrocarbons in Foods: Biological Effects, Legislation, Occurrence, Analytical Methods, and Strategies to Reduce Their Formation.

Polycyclic aromatic hydrocarbons (PAHs) are chemical compounds comprised of carbon and hydrogen molecules in a cyclic arrangement. PAHs are associated with risks to human health, especially carcinogenesis. One form of exposure to these compounds is through ingestion of contaminated food, which can occur during preparation and processing involving high temperatures (e.g., grilling, smoking, toasting, roasting, and frying) as well as through PAHs present in the soil, air, and water (i.e., environmental pollution). Differently from changes caused by microbiological characteristics and lipid oxidation, consumers cannot sensorially perceive PAH contamination in food products, thereby hindering their ability to reject these foods. Herein, the occurrence and biological effects of PAHs were comprehensively explored, as well as analytical methods to monitor their levels, legislations, and strategies to reduce their generation in food products. This review updates the current knowledge and addresses recent regulation changes concerning the widespread PAHs contamination in several types of food, often surpassing the concentration limits deemed acceptable by current legislations. Therefore, effective measures involving different food processing strategies are needed to prevent and reduce PAHs contamination, thereby decreasing human exposure and detrimental health effects. Furthermore, gaps in literature have been addressed to provide a basis for future studies.

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.

Investigating the Association between Wood and Charcoal Domestic Cooking, Respiratory Symptoms and Acute Respiratory Infections among Children Aged Under 5 Years in Uganda: A Cross-Sectional Analysis of the 2016 Demographic and Health Survey.

Background: Household air pollution associated with biomass (wood, dung, charcoal, and crop residue) burning for cooking is estimated to contribute to approximately 4 million deaths each year worldwide, with the greatest burden seen in low and middle-income countries. We investigated the relationship between solid fuel type and respiratory symptoms in Uganda, where 96% of households use biomass as the primary domestic fuel. Materials and Methods: Cross-sectional study of 15,405 pre-school aged children living in charcoal or wood-burning households in Uganda, using data from the 2016 Demographic and Health Survey. Multivariable logistic regression analysis was used to identify the associations between occurrence of a cough, shortness of breath, fever, acute respiratory infection (ARI) and severe ARI with cooking fuel type (wood, charcoal); with additional sub-analyses by contextual status (urban, rural). Results: After adjustment for household and individual level confounding factors, wood fuel use was associated with increased risk of shortness of breath (AOR: 1.33 [1.10-1.60]), fever (AOR: 1.26 [1.08-1.48]), cough (AOR: 1.15 [1.00-1.33]), ARI (AOR: 1.36 [1.11-1.66] and severe ARI (AOR: 1.41 [1.09-1.85]), compared to charcoal fuel. In urban areas, Shortness of breath (AOR: 1.84 [1.20-2.83]), ARI (AOR: 1.77 [1.10-2.79]) and in rural areas ARI (AOR: 1.23 [1.03-1.47]) and risk of fever (AOR: 1.23 [1.03-1.47]) were associated with wood fuel usage. Conclusions: Risk of respiratory symptoms was higher among children living in wood compared to charcoal fuel-burning households, with policy implications for mitigation of associated harmful health impacts.

Gastrointestinal obstruction secondary to activated charcoal granule impaction in a dog.

OBJECTIVE: To describe a serious adverse event of gastrointestinal obstruction requiring surgery following routine administration of multiple doses of activated charcoal (AC) granules, which were prescribed for carprofen toxicosis. CASE SUMMARY: A 2-year-old female neutered Airedale Terrier presented for ingestion of 207 mg/kg of carprofen. Decontamination was initiated with apomorphine to induce emesis. Along with additional supportive care, the dog received an initial dose of 75 mL of AC suspension containing sorbitol by mouth (15.6 g of AC, or 0.6 g/kg), followed by 50 g of AC granules every 8 hours for 4 additional doses. While hospitalized, the dog experienced clinical signs, including vomiting and black diarrhea, as well as bloodwork changes including mild to moderate elevations in kidney and liver enzymes. Given clinical improvement after 72 hours of hospitalization, the patient was discharged for monitoring and ongoing care at home. Two days later, the patient presented again for nausea, dark diarrhea with frank blood, and panting. Abdominal ultrasound showed findings suspicious for partially obstructive foreign material or atypical impacted fecal material partially occluding the distal ileum. Despite medical management overnight, recheck ultrasound the following day demonstrated persistent obstruction with ileal foreign material. Exploratory laparotomy and enterotomy revealed moderate distension and obstruction of the distal ileum with black granular foreign material consistent with charcoal granules. The patient remained in hospital for supportive care for 4 days following the procedure, and all clinical signs were resolved at the time of discharge. NEW OR UNIQUE INFORMATION PROVIDED: This report documents a serious adverse event of gastrointestinal obstruction associated with routine multidose AC administration, which has been occasionally reported in people but not in dogs. The potential for this complication should be taken into account when prescribing multiple doses of AC granules.

Charcoal: An ancient material with a new face.

Activated charcoal has become popular in the cosmetic industry and is found in a variety of products, including facial cleansers and soaps. For centuries, charcoal has been used as an antidote for poisonings, but now companies claim that charcoal-containing products can treat acne, dandruff, and others; however, clinical evidence does not support these claims. Patients should be counseled that the use of activated charcoal is generally safe but advised that there is a lack of evidence to support its exfoliative or anti-aging abilities.

Incidence Rate and Predictors of Globus Pallidus Necrosis after Charcoal Burning Suicide.

Objective: This study examined predictors of globus pallidus necrosis as there was a paucity of literature of globus pallidus necrosis resulted from carbon monoxide poisoning after charcoal burning suicide. Methods: A total of 67 patients who had attempted charcoal burning suicide were recruited and stratified into two subgroups based on either presence (n = 40) or absence (n = 27) of globus pallidus necrosis. Demographic, clinical, laboratory, and radiographic data were obtained for cross-sectional analysis. All patients were followed to investigate the risks for mortality. Results: The patients aged 36.8 ± 11.1 years (67.2%) were male. Patients with globus pallidus necrosis were younger (p = 0.044) and had less hypertension (p = 0.015) than patients without globus pallidus necrosis. Furthermore, patients with globus pallidus necrosis suffered from severer medical complications, i.e., fever (p = 0.008), acute myocardial injury (p = 0.022), acute rhabdomyolysis (p = 0.022), and neuropsychiatric symptoms (p < 0.001) than patients without globus pallidus necrosis. Moreover, patients with globus pallidus necrosis received less hyperbaric oxygen therapy than without necrosis (p = 0.024). Two patients (3.0%) died on arrival. In a multivariable regression model, it was revealed that acute myocardial injury (odds ratio 4.6, confidence interval 1.1-18.9, p = 0.034) and neuropsychiatric symptoms (odds ratio 8.0, confidence interval 2.0-31.4, p = 0.003), decreased blood bicarbonate level (odds ratio 0.8, confidence interval 0.7-1.0, p = 0.032), and younger age (odds ratio 0.9, confidence interval 0.9-1.0, p = 0.038) were significant predictors for globus pallidus necrosis. Conclusion: Although patients who had attempted charcoal burning suicide had a low mortality rate (3.0%), globus pallidus necrosis was not uncommon (59.7%) in this population. Further studies are warranted.

Biomass fuel as a risk factor for esophageal squamous cell carcinoma: a systematic review and meta-analysis.

BACKGROUND: The link between use of solid biomass fuel (wood, charcoal, coal, dung, and crop residues) for cooking and/or heating and esophageal squamous cell carcinoma (ESCC) is inconclusive. OBJECTIVE: We systematically reviewed the literature and performed a meta-analysis to determine whether cooking fuel type influences esophageal squamous cell carcinoma. METHODS: We searched MEDLINE, EMBASE, Web of Knowledge and Cochrane Database of Systematic Reviews for studies investigating cooking fuel and ESCC from 2000 until March 2019. We performed random effects meta-analysis stratified by the continent, World Bank's country income classifications and fuel type and calculated pooled odds ratios and 95% CIs for the risk of esophageal squamous cell carcinoma in biomass fuel users compared with non-users. RESULTS: Our analysis included 16 studies (all case-control) with 16,189 participants (5233 cases and 10,956 controls) that compared risk of ESCC among those using nonsolid fuels and biomass fuels. We found use of biomass fuel was associated with Esophageal squamous cell carcinoma with a pooled odds ratio (OR) 3.02 (95% CI 2.22, 4.11, heterogeneity (I2) = 79%). In sub-group analyses by continent, Africa (OR 3.35, 95%CI 2.34, 4.80, I2 = 73.4%) and Asia (OR 3.08, 95%CI 1.27, 7.43, I2 = 81.7%) had the highest odds of ESCC. Use of wood as fuel had the highest odds of 3.90, 95% CI 2.25, 6.77, I2 = 63.5%). No significant publication bias was detected. CONCLUSIONS: Biomass fuel is associated with increased risk of Esophageal squamous cell carcinoma. Biomass fuel status should be considered in the risk assessment for Esophageal squamous cell carcinoma.

The evolution of the characteristics of charcoal-burning suicide in Hong Kong, 2002-2013.

BACKGROUND: The use of barbecue charcoal gas for suicide led to more than 50,000 deaths in Asia since the rise of its use from 1998. Little is known whether the profile of charcoal-burning suicides changed over time. METHODS: Hong Kong's suicide data (2002-2013) were extracted from the Coroner's files. The detailed characteristics were compared between suicide by charcoal-burning and non-charcoal-burning methods, and between charcoal-burning suicides of different periods (2002-2005 vs 2006-2009 vs 2010-2013). RESULTS: People who died by suicide using charcoal burning (n = 2,188) were more likely to be male, aged 30-49 years, married (2002-2005 only), have debt, or live alone, and were less likely to have past or current psychiatric treatment or medical illness than non-charcoal-burning suicides (n = 9,666) across the three four-year periods. By contrast, compared to charcoal-burning suicides in 2002-2005, those in more recent periods (2006-2009 and 2010-2013) were more likely to be aged 50+, non-married, live alone (2006-2009 only), or have current psychiatric treatment or medical illness, and were less likely to be male (2006-2009 only), unemployed, or have debt. LIMITATIONS: There could be under-reporting of certain characteristics for charcoal-burning suicides in the Coroner's files. CONCLUSION: Charcoal-burning suicides persistently showed a distinguishable profile in Hong Kong, whilst changes in certain characteristics suggested a 'diffusion' of the method to some other groups such as older individuals. Responsible media reporting and restricting online information about new suicide methods could be potentially important prevention strategies in the early stage, whilst other strategies are needed when the methods become more commonly used.

Reducing polycyclic aromatic hydrocarbon contamination in smoked fish in the Global South: a case study of an improved kiln in Ghana.

BACKGROUND: Smoked fish is a major source of animal protein in developing countries. It is largely produced by hot-smoking on traditional kilns using fuelwood. This practice is associated with high polycyclic aromatic hydrocarbon (PAH) contamination in products, with consequences for public health. An improved kiln, comprising the FAO-Thiaroye Technique (FTT), has been introduced by the Food and Agriculture Organization of the United Nations to address such a concern. The present study investigated the efficacy of the FTT in Ghana through comparative fish smoking experiments with traditional kilns followed by determination of PAH levels [benzo(a)pyrene (BaP) and PAH4] in the products by gas chromatography-mass spectrometry. For each kiln, the effect of smoking fuel type on PAH contamination was determined. The impact of the design characteristics of the FTT on the levels of the compounds was also determined. RESULTS: Mean BaP and PAH4 levels in the FTT products were up to 1.8 and 7.6 µg kg-1 , respectively, whereas the corresponding levels in traditional kiln products were up to 70 and 395 µg kg-1 . PAH levels in FTT products were below European Union regulatory limits, whereas levels in traditional kiln products exceed such limits by up to 33-fold. Across kiln types, the use of wood fuels caused higher PAH contamination compared to the use of fully-lit charcoal as an alternative fuel. CONCLUSION: The improved kiln (FTT) is efficacious in yielding smoked fish with a PAH content lower than the levels in traditional kiln products and also below current regulatory limits. Kiln design and type of processing fuel have significant impacts on PAH contamination during fish smoking. © 2019 Society of Chemical Industry.

Chronic granulomatous pneumonia and lung rupture secondary to aspiration of activated charcoal in a French Bulldog.

A 4-year-old, spayed female French Bulldog was presented for respiratory distress and suspected aspiration pneumonia after oral administration of activated charcoal for possible ingestion of a suspected toxic dose of trazodone. The patient had a moderate volume of pleural effusion, which contained free and intracellular black particulate matter consistent with charcoal. Due to presumed charcoal aspiration with subsequent lung rupture, the right middle and right caudal lung lobes were surgically removed. Histology revealed abundant black debris consistent with charcoal and severe granulomatous inflammation. Based on the clinical, gross, and histologic findings, a diagnosis of severe, chronic, locally extensive, aspiration pneumonia and lung rupture with secondary pleuritis and mediastinitis due to charcoal aspiration was made. Aspiration pneumonia is the main complication of activated charcoal administration, which can incite extensive, granulomatous inflammation in the respiratory tract. To the authors' knowledge, this is the first report describing the cytologic and histologic findings associated with inadvertent charcoal aspiration in a veterinary species.

Effects of oral activated charcoal on hyperphosphatemia and vascular calcification in Chinese patients with stage 3-4 chronic kidney disease.

BACKGROUND: The relationship between oral activated charcoal (OAC) and hyperphosphatemia and vascular calcification is not completely clear. We observed and recorded the effects of OAC on hyperphosphatemia and vascular calcification in stage 3-4 chronic kidney disease (CKD). METHODS: In a randomized controlled study, we included 97 patients with stage 3-4 CKD. In the first phase of the experiment, the patients were randomly divided into the OAC group and placebo group. The endpoint of this phase was the development of hyperphosphatemia. The patients with hyperphosphatemia were selected into the second phase of the study. These patients underwent coronary artery multidetector computed tomography (MDCT) and were randomly divided into three groups: the OAC group, the calcium carbonate (CC) group and the lanthanum carbonate (LC) group. RESULTS: The first and second phases of the experiment were followed for 12 months. In the first phase of the experiment, there was a statistically significant difference in the proportion of patients with hyperphosphatemia between the OAC and placebo groups (28.57% vs. 79.17%, X2 = 24.958, P = 0.000). In the second phase, the differences in coronary calcification score (CACS) between the OAC group, the CC group and the LC group were statistically significant (525.5 ± 104.2 vs 688.1 ± 183.7 vs 431.4 ± 122.5, P < 0.01). CONCLUSION: Oral activated charcoal effectively delays the onset of hyperphosphatemia in patients with chronic kidney disease. OAC appears to delay the development of vascular calcifications in stage 3-4 CKD patients.

The dissipation of cyazofamid and its main metabolite in soil response oppositely to biochar application.

Biochars derived from rice straw (RS), corn straw (CS), chicken manure (CM) and tire rubber (TR) were applied to soil to investigate their effects on the dissipation of cyazofamid and its metabolite CCIM (4-chloro-5-p-tolylimidazole-2-carbonitrile), with high acute toxicity compared to cyazofamid. The enhancement of cyazofamid dissipation followed the order of CS > RS > CM, whereas TR depressed the cyazofamid dissipation. Adsorption, hydrolysis and microbial degradation were all involved in cyazofamid dissipation. CM and CS enhanced the contribution of biodegradation to cyazofamid dissipation, which might be related with the shifted microbial community. More importantly, CCIM residual was drastically increased by 8-15 times after biochar application, regardless of biochar type. In total, this study shed light on the issue of build-up of metabolites in biochar-amended soil, especially for metabolites having higher toxicities than parent compounds, providing new insights into potential risk of biochar application for soil remediation.