Activated Charcoal or Syrup of Ipecac: Which Should Be Used in Cases of Poisoning?

There's much talk about activated charcoal nowadays, especially among health care providers such as emergency medical technicians (EMTs) and paramedics. What happened to the use of syrup of ipecac? Why has it taken a back seat to activated charcoal? Syrup of ipecac was traditionally used in cases of poisoning because it caused vomiting in most people after only one dose as it not only stimulates the stomach, but also the vomiting center in the brain. Results were generally produced within 20 minutes. If there was no action, typically a second dose was administered (this is an orally administered drug) which almost always produced results.

Some of the problems associated with the use of syrup of ipecac to treat cases of poisoning include the danger of a patient aspirating vomitus, the amount of time it usually takes for results to be produced, and the relative ineffectiveness of the drug to empty more than 1/3 of the contents of the stomach. Syrup of ipecac is rarely used today by emergency medical services as a treatment for cases of poisoning. Keep in mind, however, that if a poison control center instructs you to use it, those instructions should be followed.

What Is So Much Better About Activated Charcoal?

Activated charcoal has replaced syrup of ipecac on almost every ambulance because of the superior results produced in cases of poisoning that would have traditionally been treated with syrup of ipecac. It is considered a drug by health care providers and is different from regular charcoal in that the manufacturing process produced the cracks and crevices that exist in the activated form. Those cracks and crevices are very significant when considering how activated charcoal works in cases of poisoning in which it can be used.

The drug works through a process known as adsorption (not absorption) which basically refers to one substance adhering to another or becoming attached to it. This unique property of activated charcoal causes the poison to be bound to it instead of remaining freely available to the body to be absorbed into the bloodstream. It's clear that adsorption achieves the goal of preventing or at least reducing the amount of poison that is absorbed after which permanent damage or death might occur.

There are some contraindication for the use of activated charcoal. Contraindications for the administration of a drug or the use of a medical procedure are times or situations in which that drug should not be given or that procedure should not be done unless ordered by a physician whose orders can be respectfully questioned. Laypeople would received their instructions from a poison control center while EMTs and paramedics communicate with medical direction. Although the properties of activated charcoal are truly amazing, the drug is not effective in the treatment of some types of poisons.

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Current EMT license and current NREMT certification