http://www.emedicinehealth.

com/slideshow_black_widow_brown_recluse_spiders/article
_em.htm

• Activated Charcoal Overview

• How Activated Charcoal Works
• How Activated Charcoal Is Given
• When Not to Use Activated Charcoal
• Emergency Home Care
• Synonyms and Keywords
• Authors and Editors

Activated Charcoal Overview

It was 1831. In front of his distinguished colleagues at the French Academy of Medicine,
Professor Touery drank a lethal dose of strychnine and lived to tell the tale. He had combined the
deadly poison with activated charcoal.

That's how powerful activated charcoal is as an emergency decontaminant in the gastrointestinal

(GI) tract, which includes the stomach and intestines. Activated charcoal is considered to be the
most effective single agent available. It is used after a person swallows or absorbs almost any
toxic drug or chemical.

• Activated charcoal is estimated to reduce absorption of poisonous substances up to

60%.

• It works by adsorbing chemicals, thus reducing their toxicity (poisonous nature), through
the entire length of the stomach and small and large intestines (GI tract).

• Activated charcoal itself is a fine, black powder that is odorless, tasteless, and nontoxic.

• Activated charcoal is often given after the stomach is pumped (gastric lavage). Gastric
lavage is only effective immediately after swallowing a toxic substance (within about one-half
hour) and does not have effects that reach beyond the stomach as activated charcoal does.

Activated Charcoal (cont.)

IN THIS ARTICLE
• Activated Charcoal Overview
• How Activated Charcoal Works
• How Activated Charcoal Is Given
• When Not to Use Activated Charcoal
• Emergency Home Care
• Synonyms and Keywords
• Authors and Editors

How Activated Charcoal Works

Activated charcoal exerts its effects by absorbing a wide variety of drugs and chemicals.
Adsorption is a process in which atoms and molecules move from a bulk phase (such as a solid,
liquid, or gas) onto a solid or liquid surface. In other words, the toxic substance attaches to the
surface of the charcoal. Because charcoal is not "digested," it stays inside the GI tract and
eliminates the toxin when the person has a bowel movement.

• This mechanism of action should not be confused with absorption. Absorption occurs
when a substance passes into or through a tissue, like water passing into a sponge. Once the
chemical or drug has been absorbed by the GI tract, activated charcoal can no longer retrieve
the toxic ingestion. It will only attach to substances that are still inside the stomach or
intestines.

• The charcoal is "activated" because it is produced to have a very fine particle size. This
increases the overall surface area and adsorptive capacity of the charcoal. It is produced by
adding acid and steam to carbonaceous materials such as wood, coal, rye starch, or coconut
shells. To put this in perspective, one standard 50-gram dose of activated charcoal has the
surface area of 10 football fields.

• Activated charcoal is often combined with sorbitol (a substance that stimulates the
bowels to move, like a laxative) to shorten the amount of time to move through the system and
reduce the possibility of constipation. However, to avoid adverse effects, sorbitol is not given
with every dose of activated charcoal.

• All efforts should be made to reduce adsorption of severely toxic substances, as

activated charcoal does not bind as well with these substances:

o Lithium (Eskalith, Lithobid), strong acids and bases, metals and inorganic
minerals such as sodium, iron, lead, arsenic, iodine, fluorine, and boric acid.

o Alcohol (such as ethanol, methanol, isopropyl alcohol, glycols, and acetone)

o Hydrocarbons (such as petroleum distillates and plant hydrocarbons such as

pine oil)

• Activated charcoal does not irritate the mucous membranes of the GI system. In addition
to adsorption of toxins, activated charcoal also adsorbs food nutrients, vitamins, and minerals.
However, this short-term effect is not a concern when activated charcoal is used to treat
poisoning.

Activated Charcoal (cont.)

IN THIS ARTICLE
• Activated Charcoal Overview
• How Activated Charcoal Works
• How Activated Charcoal Is Given
• When Not to Use Activated Charcoal
• Emergency Home Care
• Synonyms and Keywords
• Authors and Editors

How Activated Charcoal Is Given

Activated charcoal may be given by mouth to someone who is awake and alert. It is a black liquid
drink.

• If the person vomits the drink, another dose will be given through a nasogastric or
orogastric tube (a tube inserted through the nose or mouth, down the esophagus and into the
stomach).

• If the person is unconscious (or nearly so), an endotracheal intubation (a procedure in

which a tube is inserted through the mouth down into the trachea) may be necessary. This will
allow oxygen to be delivered and will help protect the airway and lungs from gastric content.
This will minimize the risk of the person vomiting and choking.

• Activated charcoal is usually given by a doctor. It is not a substance to be used at home.

Doctors determine the dose or amount of charcoal to give based on the patient's weight (with
special doses for children) and on how much poison was swallowed. There are some doctors
who will prescribe charcoal for emergency use in the home. This should only be done under
the direct guidance of the doctor or poison control center. In the United States, the direct
line to the poison control center is 1-800-222-1222.

• The doctor also determines when and if additional doses are given by monitoring blood
levels of the poison. Other symptoms the doctor monitors are nausea and vomiting, abdominal
pain, dizziness, and severe heart problems. Multiple doses of activated charcoal can be given
if someone swallowed large doses of long-acting, sustained release medications.

• If blood levels of the poison remain too high, the doctor may recommend kidney dialysis.
Dialysis is the best way to remove the toxin from the bloodstream.

When Not to Use Activated Charcoal

• Activated charcoal will not be given to people with an obstruction of the intestines or if
the person swallowed a corrosive agent, such as a strong acid or alkali.

• Strong acids may "burn" through the lining of the GI tract. Doctors will need to look at the
lining with an endoscope - a special instrument designed to look inside the stomach. Activated
charcoal is not to be used with this type of poison because it is difficult to see the lining of the
GI tract with the scope after charcoal is given.

• Activated charcoal can cause intestinal problems such as constipation, or it can create
clumps of foreign material. This situation can be prevented by giving a laxative such as sorbitol
to the patient, however, repeated doses with sorbitol may cause excessive diarrhea,
dehydration, and chemical imbalance.
 • If the patient is fructose intolerant, family members should notify the treating doctor, and
sorbitol will not be given with the activated charcoal. Sorbitol is a sugar substitute that acts as
a laxative to move the charcoal through the system. Babies younger than one year of age year
should not be given sorbitol because it may cause excessive fluid losses.

• If an antidote to a specific type of drug poisoning is given, then the doctor may not give
activated charcoal because the drug given as treatment will also be adsorbed. A classic
example is an acetaminophen (Tylenol overdose), in which there is a clearly established
antidote with acetylcysteine (Mucomyst).

Emergency Home Care

If you or someone you know has swallowed or breathed a poison and you or they have
signs or symptoms, such as nausea, vomiting, pain, trouble breathing, seizure, confusion,
or abnormal skin color, then you must call either an ambulance, alert your local medical
emergency system, or the National Poison Control Center in the United States (1-800-222-
1222) for guidance (this number is routed to the poison control center that serves your
area).

Place the telephone number (along with police, fire, and 911 or equivalent) near your home
phones.

The best approach to poisoning is to identify the toxic substance and call your regional poison
control center, or equivalent in your area, or go directly to the nearest Emergency Department.

• Do not induce vomiting or give syrup of Ipecac.

o Ipecac was once used to induce vomiting in poisoned patients for whom there
was a chance to get the toxin out of the body. Several advisory bodies such as the
American Association of Poison Control Centers and the American Academy of Pediatrics
have recommended that Ipecac NOT be used and that it should not even be kept in the
home. For more information on this subject go to:
http://www.poison.org/prepared/ipecac.asp

• A few poison centers recommend the use of activated charcoal in specific

circumstances. Call your local poison control center for guidance before giving it to someone.
In areas in which the poison center recommends activated charcoal, pharmacies will stock the
product, and it can be purchased over-the-counter. In general, if the local poison center does
not recommend its use at home, pharmacies will not stock it.

• Milk products may decrease the ability of the charcoal to work. Do not attempt these
types of home remedies. The best advice is to get the person to an Emergency Department.

• If the person cannot be aroused, is vomiting, or has difficulty breathing, this is a 911
emergency. Bring the container of poison or medicine bottles, if known, to the Emergency
Department.

Synonyms and Keywords

adsorbents, activated carbon, activated charcoal, poisoning, poison, absorbtion

Authors and Editors

Author: John P. Cunha, DO, FACOEP

Editor: Melissa Conrad Stöppler, MD

References: The National Poison Control Center, "What is Ipecac Syrup?"

The American Academy of Family Physicians; "Updated on the Management of Childhood Poisoning."

Author: Craig C Huston, MD, Staff Physician, Department of Emergency Medicine, Cook County Hospital, Rush
University Medical College.

Coauthor(s): Robert N Bilkovski, MD, Consulting Staff, Department of Emergency Medicine, Regional Medical
Center.

Editors: Scott H Plantz, MD, FAAEM, Research Director, Assistant Professor, Department of Emergency Medicine,
Mount Sinai School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Anthony
Anker, MD, FAAEM, Attending Physician, Emergency Department, Mary Washington Hospital, Fredericksburg, VA.

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Tuesday, Aug 17 '10, Elul 7

 Today`s Email Stories:
F-35s Might Not Stop Iran
Mortar Fire Wounds 2 Soldiers
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PA Libel as 'Peace Talks' Near
Elevator Causes Arab Anger
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1. John Bolton: One Week Left to Attack Iran

by Eli Stutz

Former U.S. Ambassador to the United Nations, John Bolton, said there is only a week left for Israel to
attack Iran if it wants to stop the Islamic Republic from creating a nuclear armament.
Blogs

On Friday, Russia announced that on August 21st, it will start loading nuclear fuel into the Bushehr reactor.
Bushehr is Iran's first atomic power station. Bolton said that once the reactor, also built by Russia, becomes
operational next week, it will be too late to attack, because the attacking it would result in the spreading of
radioactive material and hurt Iranian civilians. Instead of the Gas
Chambers, She Asked
Knife
by Arutz 7 Analysts
"If Israel wants to do something against the reactor in Bushehr, it must do so in the following eight days," Can Abbas give Israel
said Bolton. He said that in the absence of an Israeli attack, Iran would complete its goal of the something we already h
establishment of a functioning nuclear reactor. by Michael Freund
"WE LEFT, AND WE L
EVERYTHING."
by Tamar Yonah
 Bolton was skeptical of the possibility that Israel would attack Iran in the coming
days. "I do not think so, I fear that Israel has lost this opportunity," he said. Exchange Rates
Updated: 08/17/2010
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Already during his tenure in the Bush administration, Bolton stood out with his Euro 4.862
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Bolton has repeatedly stated that everything must be done to prevent Iran from obtaining a nuclear weapon,
including a military attack. Weather Forecast

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2. F-35s Might Not Reach Israel in Time to Stop Iran

by INN Staff

Israel's announced approval for the purchase of 20 U.S. F-35 fighter planes has raised questions this week
among the country's defense analysts, who wonder if the plane is the best solution for defending Israel
against Iran.

On Sunday, Defense Minister Ehud Barak approved the deal for the new plane, which is supposed to
significantly upgrade Israel's military capability, especially needed in a time when the Iranian nuclear threat
looms high. Barak confidently declared that the F-35s "will give the Air Force the best capability in the short
and long range and allow Israel to maintain aerial superiority.”

But a report in the Chinese news agency Xinhua raises doubts regarding the price tag, delivery date and
effectiveness of the estimated $2.75 billion deal.

Defense commentator Yossi Melman told Xinhua that the planes, which could take more than four years to
be delivered and made operational in Israel, may arrive too late to defend Israel against an Iranian attack.
"When those planes will arrive, they will have no use," said Melman.

Yiftah Shapir, director of the Military Balance Project at the Institute for National Security Studies in Tel Aviv
University told the news agency that the $100 million price tag per jet might rise over the next years to $150
million. He also opined that the F-35 was not as maneuverable as the F-16.

The F-35 is also reported to have a limited pay-load capability, but it is known for it's top-level computer
systems and its ability to reach an enemy target undetected. That aspect would clearly be necessary in a
strike on Iran.

"But does that mean this is the plane to stand up to the threats that Israel faces? It's a difficult question that
right now has no answers," said Shapir.

Comment on this story

3. Mortar Fire Wounds 2 Soldiers; IDF Has Not Yet Retaliated
by Tzvi Ben Gedalyahu

Two Israeli soldiers were lightly wounded in a mortar attack on the western Negev Tuesday morning, barely
12 hours after mortar shells and rockets were fired Gaza and exploded in an open field of a kibbutz in the
same area. The soldiers were carrying out engineering tasks along the security fence when they were
attacked.

The Salah al-Din Brigades, a military wing of the Popular Resistance Committees (PRC) terrorist
organization, subsequently claimed responsibility for firing the two mortars.

IDF helicopters evacuated the victims to nearby Soroka Medical Center in Be’er Sheva. Israeli media
generally ignore the attacks when no one is wounded, but this time reported on the latest explosions
following the news that soldiers were wounded.

The government and military adopted a policy in the past year to retaliate after every terrorist attack from
Hamas-controlled Gaza, and a response is likely in the next 24 hours.

Monday night, one Islamic Jihad terrorist was killed in an exchange of gunfire with the IDF after soldiers
discovered a cell trying to plant bombs along the Gaza security fence, where IDF jeeps conduct regular
patrols. One soldier was lightly wounded in the skirmish.

More than 115 rockets and mortars have been fired at Israelis since the beginning of 2010, and more than
400 rockets were fired from Gaza since the end of Operation Cast Lead early last year.

Hamas has alternately increased and reduced the number of Kassam rocket attacks. The latest escalation
may be timed to interfere with the apparent likelihood that the Ramallah-based Palestinian Authority will
agree to direct talks with Israel over a proposed new Arab country within Israel’s borders.

The PA is headed by the Fatah faction, which lost control of Gaza in a bloody militia war with Hamas three
years ago.

Comment on this story

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4. Central Israel Oil Discovery: 1.5 Billion Barrels

by Tzvi Ben Gedalyahu

Estimates of the amount of oil in the Rosh HaAyin discovery have rises to 1.5 billion barrels, and there is
more oil off-shore, but it is not yet known how much of the “black gold” can be extracted for commercial
use.

The new estimate, along with the gas and oil finds off the Mediterranean Coast, raise the likelihood that
Israel will be self-sufficient for energy for the next three decades and even become an exporter of gas. The
amount of oil at Rosh HaAyin represents a tiny percentage of Israel's oil consumption, but development is
continuing in the area as well as in the Dead Sea.

Economists have noted that the discoveries will have a huge impact on society, creating more jobs and
strengthening the shekel against word currencies.

Investors in the project at Rosh HaAyin, located on the edge of Samaria and several miles east of Tel Aviv,
have been waiting anxiously for months for news about the amounts oil underground at the Megged 5 oil
well. The full engineering report will not be available until mid-September, but the company has decided to
adopt the recommendation in the initial report.

Oil samples were found as having high quality with very little sulfur, and the amount of water in the samples
was less than 10 percent.

It added, “A reasonable estimate of the amount of oil...is 1.525 billion barrels of oil” but warned that the final
estimates may be lower, with a chance that they could even be higher. The report does not include estimate
of other sections in the field.

Previous reports estimated that daily production could reach 382 barrels a day. The latest company
statement said it is will not be known before next month the new estimated production rate, but it should
reach at least 450 barrels a day.

Comment on this story

5. PA Readies for Talks but Keeps Up 'Israel Poisoned Arafat' Libel

by Eli Stutz courtesy of Palestinian Media Watch

As the PA gears up for talks with Israel, a Palestinian Media Watch report reveals that it continues to
promote the libel that Israel poisoned Yasser Arafat, in an attempt to establish him as a national martyr and
create an environment of hate. PMW says the libel includes charges that the United States encouraged
Israel to poison Arafat.

PMW Director Itamar Marcus told Israel National News, "We hear children in Palestinian-controlled regions
referring to this libel regularly. It appears everywhere, and the idea is to make Arafat into a martyr. All this
hate material is not just isolated name calling. It's being built into a basic part of Palestinian identity. It is
being blended together into a comprehensive attempt at delegitimizing Israel."

Marcus had insights into the nature of the libel itself. "We believe that poisoning specifically was chosen as
the charge because in the Hadith [writings on Mohammed], Mohammed is said to have been killed by
poisoning, and we think that there is an attempt to raise Arafat to that tremendous status level [of
Mohammed]," he said.

The PMW Report:

The PLO claims Arafat was killed with the "approval and help of the United States." Palestinian Media
Watch has for years documented this recurring libel, which is spread by PA and Fatah leaders, academics
and clerics. It is even disseminated through cultural events and media messages for children.

The following accusation that Israel killed Arafat, written by a Fatah member of the PLO's
Palestinian National Council, appeared this week in the official PA daily newspaper Al-Hayat Al-
Jadida, as translated by PMW:

Khaled Mismar, member of the PLO's Palestinian National Council:

"[In 2003] Israel, with the support of the new American administration of President Bush, laid oppressive
siege to our late symbol, Yasser Arafat, until they got him with poison, since they weren't able to kill him
using their tanks, which besieged his home in Ramallah. The details of the story are known to everyone,
young and old, among our Palestinian people and throughout the world."

[Al-Hayat Al-Jadida, Aug. 10, 2010]

Nashat Al-Aqatsh, a lecturer at Bir-Zeit University, said in July while discussing the peace process:

"In the past [Israel claimed] no Palestinian partner existed, and they [Israel] killed the late Palestinian
President, Yasser Arafat."

[PA TV (Fatah), July 27, 2010]

Earlier this summer, in a dramatic performance at a PLO cultural festival, two young Palestinian boys
lamented Arafat's death, and compared his death at the hands of the Jews to the death of Jesus:

Boy 1 [addressing Arafat]: "Father, father the Elder [Arafat]. Why did it happen this way? Why did it
happen this way? Death chose you, and you did not complete the path."

Boy 2: "Do not ask why it happened this way. Yesterday they crucified Jesus; today they poisoned the
father, the Elder [Arafat]."

[PA TV (Fatah), June 4, 2010]

The PA Minister of Culture was present at this performance.

Click to see PMW web site with more examples documenting the ongoing PA libel that Israel killed Arafat.
 Comment on this story

6. Arabs Angered by Western Wall Plaza Elevator

by Chana Ya'ar

Arabs are fighting plans for an elevator to allow disabled Jews to reach the Western Wall, claiming the
project is a threat to the Al Aqsa mosque on the Temple Mount.

The 56-meter elevator would be located in the Jewish Quarter next to the Aish HaTorah Yeshiva, according
to the media watchdog Independent Media Review Analysis (IMRA).

The Al Aqsa Foundation, however, claimed Monday the $10 million structure is to be located adjacent to the
Al Aqsa mosque on the Temple Mount, and is whipping up a frenzied protest against the project.

The location of the elevator, to be named after Baruch Klein, the American businessman funding the project
– and the yeshiva – is actually far from the mosque, on the other side of the Western Wall plaza.

But the project is being seen by the Al Aqsa Foundation as a threat to the Al Aqsa Mosque, according to the
Palestinian Authority-linked Ma'an news agency.

The Al Aqsa Foundation also claimed in a statement that the area in front of the wall could be used as a
base from which to attack the mosque compound. Moreover, it said the project was intended to prevent
Muslim worshipers from reaching the mosque, while increasing the presence of Jews in the area.

The mosque, which sits atop the Temple Mount and adjacent to the Western Wall, is considered Islam's
third holiest site. The Temple Mount on which it is built, however, is the holiest site in the Jewish faith, and
is where the Holy of Holies in both the First and Second Temples was located.

Previous Arab and Muslim incitement over building projects in the Jewish quarter of the Old City has led to
riots and attacks on Jewish civilians. In June 2007 the construction of a pedestrian pathway near the
Western Wall was met with Arab riots in Jerusalem and terrorist rocket attacks from Gaza, in September
2009 several people were wounded in a Muslim riot that began when a group of Jews attempted to tour the
Temple Mount, and in early 2010 riots broke out across Jerusalem over the restoration of the Hurva
synagogue in the Jewish quarter.

Comment on this story

 7. PA Gov't Supports Violence Against Israel
- in Arabic
by Chana Ya'ar

The Palestinian Authority is continuing to express its

support for violence against Israeli citizens in Arabic-
language media, despite English-language
propaganda insisting the PA wants peace. The
interview, broadcast August 6 on PA TV (Fatah), was
translated by the media watchdog Palestinian Media
Watch (PMW).

Senior Fatah Central Committee member Jibril

Rajoub, a leading PA government official, reiterated the faction's support for “armed struggle” in the
interview. “At the [sixth Fatah] Conference, we affirmed the struggle in all its forms, including resistance and
the armed struggle... We agreed on it unanimously, about both the movement's aims and its principles,
including the resistance and the armed struggle,” he said.

“The [armed] struggle, as we see it, is not an aim; it is not a hike or a pleasure cruise. [Armed] resistance
has circumstances, considerations, and factors – whether national, regional or international. It must cause
pain to the Occupation; it must be connected to a political platform,” Rajoub explained.

Former PA Prime Minister Ahmad Qureia (Abu Ala), who currently serves as the PA's chief negotiator, said
in an interview published one day earlier in the London-based Arabic daily newspaper Al Sharq Al-Awsat
that “all options are open,” including armed resistance.

“Negotiators, political activity, popular activity, and [armed] resistance... we must continue with it,” Qureia
said, adding that all of the options were viable. “And if [resistance] gives me [benefit] without costing me,
yes,” that option is also a good one, he said.

Both men echoed sentiments expressed earlier in the summer by Nabil Shaath, a member of the PA
Parliament, a Fatah “Commissioner of Foreign Relations” and a member of the Fatah Central Committee.

In two separate interviews with Arabic-language media in June (Al-Dustur daily newspaper in Jordan, and
Al-Hayat Al-Jadida in the PA), Shaath underscored the PA's commitment to violence against Israel.

“The Palestinian people has the right to defend itself, and it has the right to act in the way of the armed
struggle. We have acted in this way for 100 years,” he said in the interview with Al-Hayat Al-Jadida. “Fatah
led [the armed struggle] for 23 years, and Hamas adopted it for 15 years. We are proud of all of our
Shahids (martyrs) and it is our right to return to the armed conflict whenever we view that as being in our
people's interest.”

Comment on this story

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