What is activated charcoal?

An organic substance, such as wood, peat or coconut shell is burned in a controlled process producing a substance containing a matrix of relatively large pores. It then undergoes an oxidation ("activation") step in which a finer internal pore system is created. The result is a substance with a remarkable surface area. Currently available medicinal activated charcoals have surface areas ranging from 900 to over 2000 m2/g. In other words, a single gram of this material has over half an acre of surface area! As a raw material, activated charcoal is a tasteless and odorless fine black powder. Pore and particle sizes are varied according to the intended application.

Although it is widely used today in industrial applications to purify and detoxify, its use in medicine actually goes back to ancient times. The first systematic studies to demonstrate its remarkable adsorptive properties were in the early 1800's. Despite continued studies, activated charcoal in the routine treatment of poisoning did not begin to see widespread use until the 1980's.

In what forms are medicinal activated charcoal products available?

Most antidotal charcoal in the US is in the form of a suspension, with bottles or tubes containing either 15, 25 or 50 grams (in 72, 120 or 240 ml. of volume respectively). Many companies also market a suspension containing sorbitol which not only acts as a thickener and sweetener but as a powerful cathartic. These liquid forms are either drunk from a cup or introduced into the stomach via a lavage tube depending on the clinical situation and cooperation of the patient. The use of cathartics in the treatment of poisoning is no longer encouraged; the diarrhea which results can be severe producing electrolyte disturbances, dehydration and even death. Powdered or granulated charcoal for the treatment of poisoning is used extensively in Europe and to a lesser extent in the US. Water is added and the mixture agitated or stirred; however, the charcoal mixes poorly in water.

Activated charcoal is also sold widely over-the-counter in tablet and capsule form for the treatment of gas and upset stomach. In Europe it is often used for this purpose in the place of an antacid. However, the amounts of charcoal in each tablet or capsule are too small to make it practical for use in the poisoning situation, not to mention the inability of children to swallow tablets.

Essentially all of the medicinal activated charcoals used in the US come from the Dutch company Cabot Norit or the Swedish company, Jocobi Carbons.  Most of the medicinal activated charcoals have coconut shell as the source.