How does activated charcoal work as an antidote. What are the benefits of using activated charcoal for poisoning. When should activated charcoal be administered for optimal effectiveness. What are the potential side effects of activated charcoal treatment. How is activated charcoal prepared and administered in emergency settings.

The Science Behind Activated Charcoal’s Detoxifying Properties

Activated charcoal is a remarkable substance with extraordinary adsorptive capabilities. But how exactly does it work to combat poisoning and overdoses? The key lies in its unique structure and chemical properties.

Activated charcoal is produced by burning carbon-rich materials like wood at extremely high temperatures to create charcoal. This charcoal then undergoes an “activation” process that dramatically increases its surface area and binding sites. The result is a highly porous material with an immense internal surface area – just one teaspoon of activated charcoal has a surface area comparable to that of an entire football field!

This expansive surface area allows activated charcoal to adsorb (bind to its surface) a wide range of substances, including many drugs and toxins. When ingested, it can prevent these harmful compounds from being absorbed from the gastrointestinal tract into the bloodstream.

How does activated charcoal differ from regular charcoal?

It’s crucial to understand that activated charcoal is fundamentally different from regular charcoal or burned toast. The activation process creates a much more effective adsorbent material. Attempting to use regular charcoal or burned food as a substitute is ineffective and potentially dangerous.

The History and Evolution of Activated Charcoal in Medicine

The use of charcoal for medicinal purposes has a long and fascinating history. One of the earliest documented demonstrations of its powerful properties occurred in 1813. In a daring experiment, French chemist Bertrand ingested a lethal dose of arsenic trioxide mixed with activated charcoal – and survived.

This dramatic demonstration paved the way for further research and applications. Over time, activated charcoal has been used for water purification, as a general remedy for various ailments, and most importantly, as a critical treatment for poisoning and overdoses.

When did activated charcoal become a standard treatment for poisoning?

While its properties have been known for centuries, activated charcoal became more widely adopted as a standard treatment for poisoning in the latter half of the 20th century. Today, it is the most commonly used method of gastrointestinal decontamination in emergency rooms worldwide.

The Role of Activated Charcoal in Modern Poison Control

In contemporary emergency medicine, activated charcoal plays a crucial role in treating many cases of poisoning and overdose. However, it’s important to note that it’s not always the first line of treatment, and its use depends on various factors.

Contrary to popular belief, “stomach pumping” or gastric lavage is relatively rare in modern poison control. Instead, supportive care and specific antidotes (when available) are often the primary interventions. When gastrointestinal decontamination is necessary, activated charcoal is typically the method of choice.

In what situations is activated charcoal most effective?

Activated charcoal is most effective when administered soon after ingestion of a toxic substance. Its efficacy can vary depending on the specific poison or drug involved. Some substances are more readily adsorbed by activated charcoal than others.

• Most effective: Many medications, including acetaminophen, aspirin, and tricyclic antidepressants
• Less effective: Alcohols, heavy metals, and corrosive substances

Administration and Dosage of Activated Charcoal

In an emergency room setting, activated charcoal is typically administered as a liquid suspension. The black powder is mixed with water or, in some cases, a sweetened beverage to improve palatability, especially for children.

Some activated charcoal products contain sorbitol, a sweetener that also acts as a laxative. This can help expedite the passage of the poison or drug through the digestive system, potentially reducing absorption further.

What is the typical dosage of activated charcoal?

The dosage of activated charcoal can vary depending on the patient’s age, weight, and the specific poisoning situation. However, a general guideline for adults is often around 50-100 grams as an initial dose. For children, the dose is typically adjusted based on body weight.

It’s crucial to note that these doses are significantly higher than what’s available in over-the-counter activated charcoal products. This is one of the many reasons why activated charcoal should only be administered under medical supervision in cases of poisoning or overdose.

Potential Side Effects and Precautions

While activated charcoal is generally well-tolerated, it’s not without potential side effects. Understanding these risks is crucial for both medical professionals and patients.

What are the most common side effects of activated charcoal?

The most frequently reported side effects of activated charcoal treatment include:

• Nausea and vomiting: Often in response to the gritty texture of the charcoal mixture
• Aspiration: If a patient is very drowsy, there’s a risk of vomiting and inhaling the activated charcoal
• Constipation: In some cases, especially with repeated doses

It’s worth noting that these side effects are generally considered minor compared to the potential benefits in cases of serious poisoning.

The Limitations of Over-the-Counter Activated Charcoal Products

While activated charcoal is available over-the-counter in many places, these products are not suitable for treating poisoning or overdoses at home. There are several important reasons for this:

1. Potency: Over-the-counter products may not be as “activated” as those used in emergency rooms, potentially reducing their effectiveness.
2. Dosage: The amount of activated charcoal needed for poisoning treatment is much higher than what’s typically available in OTC products. For example, to match an emergency room dose could require hundreds of OTC tablets.
3. Timing: The effectiveness of activated charcoal decreases rapidly with time after ingestion of a toxic substance. Attempting home treatment could delay proper medical care.
4. Monitoring: Poisoning cases often require close medical monitoring and additional interventions that can’t be provided at home.

Are there any legitimate uses for over-the-counter activated charcoal?

Some OTC activated charcoal products claim to help with issues like bad breath or general “detoxification.” However, the scientific evidence supporting these uses is limited. The primary medically recognized use for activated charcoal remains the treatment of certain types of poisoning under professional medical supervision.

The Importance of Professional Medical Care in Poisoning Cases

When it comes to suspected poisoning or overdose, seeking immediate professional medical care is crucial. Attempting to treat these situations at home, even with activated charcoal, can be dangerous and potentially life-threatening.

Why is it dangerous to attempt home treatment for poisoning?

There are several reasons why home treatment of poisoning is strongly discouraged:

• Proper assessment: Medical professionals can accurately assess the severity of the poisoning and choose the most appropriate treatment.
• Tailored treatment: The effectiveness of activated charcoal varies depending on the specific substance involved. Doctors can determine if it’s the best course of action.
• Timing: The window for effective use of activated charcoal is often short. Delaying professional care can reduce its efficacy.
• Monitoring: Poisoning cases often require ongoing monitoring and may need additional interventions that can’t be provided at home.
• Proper administration: Activated charcoal needs to be given in the correct form and dosage, which is best done in a medical setting.

If you suspect poisoning, the best course of action is to immediately contact your local poison control center or emergency services. In the United States, you can reach the Poison Control Center at 1-800-222-1222.

Advancements and Future Directions in Poison Treatment

While activated charcoal remains a cornerstone of poisoning treatment, research in toxicology and emergency medicine continues to advance. Scientists and medical professionals are constantly working to improve our understanding of different toxins and develop more effective treatments.

What new developments are occurring in poison treatment?

Some areas of ongoing research and development include:

• Targeted antidotes: Developing more specific antidotes for particular toxins.
• Improved activated charcoal: Enhancing the adsorptive properties and palatability of activated charcoal formulations.
• Alternative adsorbents: Investigating other materials that may be effective for certain types of poisoning.
• Enhanced supportive care: Improving techniques for managing the systemic effects of poisoning.
• Toxin detection: Developing faster and more accurate methods for identifying unknown poisons.

These advancements promise to further improve outcomes for poisoning patients in the future. However, activated charcoal is likely to remain an important tool in the treatment of many types of poisoning for the foreseeable future.

In conclusion, activated charcoal is a powerful and often life-saving treatment for many types of poisoning and overdoses. Its remarkable adsorptive properties make it highly effective at preventing the absorption of many toxic substances. However, it’s crucial to remember that activated charcoal should only be administered under professional medical supervision. In cases of suspected poisoning, immediate contact with poison control or emergency services is always the best course of action.

Activated charcoal | Poison Control

The Bottom Line

Activated charcoal keeps swallowed drugs and poisons from being absorbed from the gut into the bloodstream. It’s a highly effective treatment for many poisons.

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The Full Story

When people have to go to an emergency room because of an overdose, they are often worried about getting their stomachs “pumped.” In reality, gastric lavage (stomach pumping) does not happen very often. Most overdoses are treated with supportive care. For example, if the person’s blood pressure is low, IV fluids and medications might be given to raise blood pressure. There are also a few specific antidotes that can be of great benefit. However, when gastrointestinal decontamination is performed, it is typically accomplished with a product known as “activated charcoal,” mixed and taken by mouth or feeding tube in the emergency room.

Activated charcoal is a special form of carbon that can bind other substances on its surface (adsorption). That is why it is used for water filtration. It is also used to adsorb drugs in the gut so the drugs don’t enter the body. Activated charcoal is made by burning carbon-rich materials, such as wood, at very high temperatures to create charcoal. The resulting product is a black, odorless powder. The charcoal is then “activated” through a special process that makes lots of holes and crevices on the charcoal particles to increase surface area and available binding sites. One teaspoonful of activated charcoal has about the same total surface area as a football field! In the emergency room, the black powder is mixed with a liquid and given to a poisoned patient to drink. It is typically mixed with water but it can be mixed with a sweet beverage for children. Some activated charcoal products contain a sweetener called sorbitol that adds sweetness and is also a laxative. Some studies show that pushing the poison or drug through the gut faster might also decrease the amount that is absorbed into the body.

Activated charcoal has historically been used to clean water and as a treatment for many ailments. An early demonstration of the adsorptive properties of activated charcoal occurred in 1813 when the French chemist Bertrand drank 5 grams of arsenic trioxide (a very poisonous substance) mixed with activated charcoal and survived.

The efficacy of activated charcoal depends on how quickly it is given and the poisonous substance swallowed. The sooner activated charcoal is given after a drug or chemical is swallowed, the better it works.

Some activated charcoal products sold over-the-counter make claims of adsorbing toxins and decreasing bad breath. It is not recommended to use activated charcoal at home to treat an overdose. If a poisoning is serious enough to warrant the use of activated charcoal, the person should be monitored in an emergency room. Over-the-counter products might not be as “activated” as the activated charcoal used in the emergency room so they might not be as effective. Over-the-counter activated charcoal typically comes in 250 mg tablets. To provide the same dose given in the emergency room could require hundreds of tablets.

There are some internet sites that encourage making activated charcoal at home or using other carbon sources such as burned toast or charcoal briquettes. These products are not effective and should never be used.

The few adverse effects of activated charcoal are:

• nausea and vomiting after drinking it, often in response to the gritty feeling of the mixture, and 
• vomiting and inhaling (aspirating) the activated charcoal. This could happen if the patient is very drowsy.

Overall, activated charcoal is well tolerated. There are studies that show that it works well for some ingestions and not so well for others. It is the most widely used method of gastrointestinal decontamination in emergency rooms today. 

Pela Soto, PharmD, BSHS, BS

Certified Specialist in Poison Information

Poisoned?

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1-800-222-1222


or

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Prevention Tips

• Do not try to treat an overdose with activated charcoal at home.
• Do not confuse burned toast or barbecue briquettes with activated charcoal; they don’t work.

This Really Happened

A physician called Poison Control from the ER to discuss a patient who had intentionally taken aspirin tablets in an effort to harm herself.  The ingestion was approximately 45 minutes earlier. The patient was awake and alert, but tearful. She claimed to have taken “several handfuls” of aspirin.

Poison Control recommended that the patient receive activated charcoal as soon as possible. It was also recommended that the emergency physician measure the aspirin concentration in her blood every 2 hours until the aspirin concentration dropped. Poison Control also recommended other laboratory tests appropriate for an aspirin overdose.

During a follow-up call from Poison Control, the nurse caring for the patient reported that the patient drank the activated charcoal without issue. Her blood aspirin concentration initially rose but then declined steadily. Once the blood aspirin concentration was down to a safe range, the patient was medically cleared and transferred to a psychiatric facility. No permanent damage was anticipated. 

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For More Information

Mayo Clinic. Activated Charcoal [Internet]. Rochester (MN). 2014 December [cited 2015 Feb 27]. 

References

Chyka PA, Seger D, Krenzelok EP, Vale JA. American Academy of Clinical Toxicology and European Association of Poison Centres and Clinical Toxicologists. Position paper: Single-dose activated charcoal. Clin Toxicol (Phila) 2005;43(2):61-87.

Hoffman RS, Howland M, Lewin N, Nelson L, Goldfrank L. Goldfrank’s toxicologic emergencies. 10th ed. New York: McGraw-Hill; c2011. A1 Antidotes in depth: activated charcoal; p.108-13.

University of Kentucky. Historical production and use of carbon materials. [Internet]. 2015 January [cited 2015 Feb 27].

Erickson T. Famous (And Not So Famous) Events In Toxicological History; Activated Charcoal: Universal Antidote or Black Magic. [Internet]. AACTion Volume 13, Number 2. [Accessed 27 February 2015].

Poisoned?

Call


1-800-222-1222


or

HELP ME online

Prevention Tips

• Do not try to treat an overdose with activated charcoal at home.
• Do not confuse burned toast or barbecue briquettes with activated charcoal; they don’t work.

This Really Happened

A physician called Poison Control from the ER to discuss a patient who had intentionally taken aspirin tablets in an effort to harm herself.   The ingestion was approximately 45 minutes earlier. The patient was awake and alert, but tearful. She claimed to have taken “several handfuls” of aspirin.

Poison Control recommended that the patient receive activated charcoal as soon as possible. It was also recommended that the emergency physician measure the aspirin concentration in her blood every 2 hours until the aspirin concentration dropped. Poison Control also recommended other laboratory tests appropriate for an aspirin overdose.

During a follow-up call from Poison Control, the nurse caring for the patient reported that the patient drank the activated charcoal without issue. Her blood aspirin concentration initially rose but then declined steadily. Once the blood aspirin concentration was down to a safe range, the patient was medically cleared and transferred to a psychiatric facility. No permanent damage was anticipated. 

How and When to Use Charcoal for the Dreaded Stomach Flu

If you’ve had the stomach flu, there’s almost nothing you wouldn’t do to get back on your feet faster, and that is exactly how a special kind of charcoal might be able to help.

Even though charcoal makes most of us think of glowing embers and yummy barbecue, activated charcoal has stomach soothing medicinal properties that can help resolve stomach bugs. 

Given that 19 to 21 million Americans get the stomach flu each year, you’ll want to remember this charcoal remedy the next time you or a loved one needs some digestive support.

What is the Stomach Flu?

The stomach flu, stomach bugs, or even food poisoning are all often caused by bacterial infections or viruses–most commonly Norovirus. The inflammation that happens as a result is called viral gastroenteritis, and symptoms include:

• Nausea
• Vomiting
• Diarrhea
• Gas, bloating

Symptoms usually come on quickly and can have you off your feet from 1 to 3 days.

Common treatment recommendations include drinking fluids, getting rest, and following the BRAT (bananas, rice, applesauce, toast) diet—but adding charcoal might help get rid of the bacteria faster.

Related: 3 Detox Methods That Actually Work

What Is Activated Charcoal?

Activated charcoal is a fine, black powder made from a variety of carbon-based materials like bamboo, wood, or coconut shells. These materials are decomposed by burning at an incredibly high temperature, then combined with oxygen, which makes them “activated”.

Indigenous peoples in North America, as well as in Egypt, capitalized on its antifungal and antibacterial properties for centuries (1).  

The process of activating charcoal creates millions of tiny pores on the surface, making it incredibly absorbent, and that’s how it works in your stomach. It essentially absorbs or mops up toxins and harmful bacteria, preventing them from being absorbed by your gut lining. 

Why do people take activated charcoal?

Doctors often use activated charcoal to treat certain instances of poisoning or drug overdose, but it may also serve as a remedy for stomach bugs that cause nausea and vomiting.

The theory is that activated charcoal can absorb the bacteria responsible for causing stomach flu (the same way it is used to absorb poisons). Because the process of activating charcoal makes it ultra-absorbent, it’s one of the most effective ways to rid your body of harmful toxins. You can also have a virus that can cause the same sort of tummy troubles, and it may help with the symptoms.

Activated charcoal is even considered more effective than stomach pumping in poisoned patients because of its incredible ability to absorb different kinds of toxins (with a few exceptions) (2). 

Activated Charcoal and Diarrhea

The main causes of diarrhea are usually toxins or bacterial infection, similar to what causes most stomach bugs. Because activated charcoal is especially good at attracting and eliminating harmful toxins and bacteria, one study shows it’s an effective treatment for diarrhea with exceptionally few side effects compared with other treatments (3).

How should I take charcoal?

If symptoms worsen, or you develop a fever or other reaction, stop taking activated charcoal and call your doctor immediately.

After you’ve eaten a questionable food, or begin to feel the symptoms of a stomach bug, you can mix activated charcoal with a glass of water, or in applesauce for a more pleasant flavor.

A common recommendation for activated charcoal is 500 to 1,000 mg taken 2 to 3 times per day (4). This may not sound like a lot, but 1 gram (1,000) mg of activated charcoal has about the same surface area as a tennis court!

You can find activated charcoal in powder or capsules in most health food stores. When purchasing supplements, it’s important to choose high-quality, GMP-verified products when possible.

Can I give activated charcoal to my children?

It’s safe for children to take activated charcoal, but always check with your pediatrician before giving to your child.

Once you receive the ‘okay’ start with ¼ of a teaspoon in some applesauce and repeat no more than 2 times a day. If you or your child continue to have abdominal pain or persistent fever, you must see your doctor.

Healing the Gut After a Stomach Bug

It can take several days before your stomach returns to normal and is able to properly repair damage from the inflammation resulting from a bacterial infection.

I add a scoop of Belly Fix with fermented greens and Ayurvedic remedies, plus extra L-glutamine to help repair my stomach lining. This is an easy addition to my daily routine if I feel that my gut needs extra help, or if I’ve eaten something I shouldn’t have.

For a step-by-step plan to reset your gut and rebuild healthy digestion, learn more about the 21-Day Belly Fix.

Resources

1. https://www.encyclopedia.com/medicine/diseases-and-conditions/pathology/activated-charcoal 
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1676641/pdf/bmj00002-0006.pdf
3. https://pubmed.ncbi.nlm. nih.gov/29231746/ 
4. https://www.ncbi.nlm.nih.gov/books/NBK482294/ 

Activated carbon. Great Russian Encyclopedia

Chemical compoundsChemical compounds

Activated carbon (active carbon), carbon absorbent with a developed porous structure. At 87–97% (by mass) it consists of carbon C, it also contains hydrogen H, oxygen O and substances introduced into activated carbon during its production. The ash content of activated carbon can be 1–15% (sometimes it is anesthetized to 0.1–0.2%).

Pores in activated carbon are classified according to their linear dimensions x (half-width – for slit-like pore model, radius – for cylindrical or spherical): x ⩽ 0.6–0.7 nm – micropores; 0.6–0.7< х< 1.5–1.6 nm – supermicropores; 1.5–1.6 < x < 100–200 nm – mesopores; x > 100–200 nm – macropores.

For adsorption in micropores (specific volume 0.2–0.6 cm ³ /g), commensurate in size with adsorbed molecules, the volume filling mechanism is mainly characteristic. Similarly, adsorption also occurs in supermicropores (specific volume 0.15–0.2 cm ³ /g) – intermediate areas between micropores and mesopores. In this region, the properties of micropores gradually degenerate, while the properties of mesopores appear.

The mechanism of adsorption in mesopores consists in the sequential formation of adsorption layers (polymolecular adsorption), which ends with the filling of pores by the mechanism of capillary condensation. For ordinary activated carbons, the specific mesopore volume is 0.02–0.10 cm ³ /g, the specific surface area is from 20 to 70 m ² /g; however, for some activated carbons (for example, clarifying ones), these figures can reach 0.7 cm ³ /g and 200–450 m ² /g, respectively.

Macropores (specific volume and surface, respectively, 0.2–0.8 cm ³ /g and 0.5–2.0 m ² /g) serve as transport channels that bring molecules of absorbed substances to the adsorption space of grains ( granules) of activated carbon. To impart catalytic properties to coal, as a rule, special additives are introduced into macro- and mesopores.

Activated carbon often contains all types of pores, and the differential distribution curve of their volume by size has 2-3 maxima. Depending on the degree of development of supermicropores, activated carbons are distinguished with a narrow distribution (these pores are practically absent) and wide (substantially developed).

Activated carbons adsorb vapors of substances with relatively high boiling points (e.g. benzene) well, volatile compounds worse (e.g. NH ₃ ). At a relative vapor pressure p _p / p _us less than 0.10–0.25 (p _p is the equilibrium pressure of the adsorbed substance, p _us is the saturation vapor pressure). Activated carbon slightly absorbs water vapor. However, at (р _р / р _us ) > 0.3–0.4, noticeable adsorption is observed, and in the case of (р _р / р _us )≈1, almost all micropores are filled with water vapor. Therefore, their presence can complicate the absorption of the target substance.

The main raw materials for the production of activated carbon are coal semi-coke, carbonaceous plant materials (eg charcoal, peat, sawdust, nut shells, fruit pits). The carbonization products of this raw material are subjected to activation (in most cases, steam-gas – in the presence of vapor H ₂ O and CO ₂ , less often – chemical, i.e. in the presence of metal salts, for example ZnCl ₂ , K ₂ S ) at 850–950 °C. In addition, activated carbon is obtained by thermal decomposition of synthetic polymers (for example, polyvinylidene chloride).

Activated carbon is widely used as an adsorbent to absorb vapors from gaseous emissions (for example, to purify air from CS ₂ ), to capture vapors of volatile solvents for the purpose of their recovery, to purify aqueous solutions (for example, sugar syrups and alcoholic beverages), drinking and waste water, in gas masks, in vacuum technology, for example, for creating sorption pumps, in gas adsorption chromatography, for filling odor absorbers in refrigerators, purifying blood, absorbing harmful substances from the gastrointestinal tract, etc. Activated carbon is also a carrier of catalytic additives and polymerization catalyst.

N. S. Polyakov. First published: Encyclopedia of Chemistry, 1988. Publication date: June 5, 2023 at 13:14 (GMT+3)

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How to do gastric lavage | CE VetGirl Vet Blog

A huge shout out to Dr. Alex Molldrem, ER veterinarian extraordinaire at the Minnesota Emergency and Animal Referral Center for making this CE VETgirl veterinary video for us! Similarly, thanks to NAVK VetEdge for posting this content!

You may not like gastric lavage, but for certain poisonings it is necessary. VETgirl’s general guidelines for when gastric lavage should be performed include:

1) Ingestion of toxic substances with a narrow safety margin (such as calcium channel blockers, metaldehyde, ivermectin/moxidectin, organophosphates/carbamates, baclofen, and cholecalciferol products)

2 ) Ingestion of a toxic dose approaching the LD50.

3) Ingestion of a large amount of product that may form a bezoar or nodule (which could lead to potential foreign body obstruction (e.g. iron tablets, large aspirin swabs, bone meal, etc.)

4) Patient with symptoms, which is contraindicated in inducing vomiting (due to excessive sedation, unconsciousness, tremors or convulsions, etc.), which still requires controlled decontamination.

So how do you do it? This VETgirl V-Blog demonstrates how to gastric lavage. Follow the instructions below!

Gastric lavage steps:
1. Always be prepared – get all supplies in an organized manner:
• white tape
• gag
• sterile lubricant (e.g. KY)
• gauze
• warm lavage fluid ( eg tap water) in bucket
• bilge/drain or stomach pump (or funnel if bilge is not available)
• step
• sedatives (eg pre-painted and labeled appropriately)
• ETT with high volume, low pressure cuff (to prevent necrosis of the trachea)
• Empty syringe for inflation of the cuff
• ETT attachment and attachment material
• Consumables for IV catheter
• Activated charcoal pre-filled in 60 ml syringes, ready to use (dose: 1-5 g/kg of charcoal)
• anti-sedative agents (eg naloxone, yohimbine, etc. )
• antiemetic (eg maropitant)

2. Install IV access.

3. Calm and intubate with ETT; secure the ETT in place and connect it to a source of oxygen +/- inhalation anesthesia. Inflate the cuff to prevent aspiration of stomach contents or lavage fluid.

4. Properly observe the patient.

5. Consider administering an antiemetic to prevent secondary aspiration (eg maropitant, ondansetron, etc.).

6. Place the patient on the chest or on the right side.

7. Pre-measure an appropriately sized orogastric tube to the last rib (so you know the maximum distance the tube can be inserted) and mark this point with white tape.

8. Lubricate the orogastric tube and pass the tube into the stomach with a gentle twisting motion. My hint? Blow on the other end of the tube to inflate the esophagus with air to make it easier to pass the tube.

9. Make sure your orogastric tube is in the correct place – if your patient is intubated, this is not a problem; however, for those who are not airway secure, the correct insertion of the orogastric tube should be confirmed by one of the following methods:
• Palpation of the orogastric tube during palpation of the abdomen.
• Blowing into an orogastric tube while listening for “bubbles” or blowing into the stomach.
• Palpation of the neck for two tubular structures (trachea, esophagus with tube insertion).

10. Once you have identified a suitable location, introduce warm water by gravity through a funnel, bilge/drain or stomach pump (I prefer a bilge pump). For gastric sounding, you can use a copious amount of lavage fluid. Keep in mind that the stomach contains approximately 60-90 ml / kg.

11. Attempt to collect fluid through a gastric tube by gravity, pouring it directly into an empty bucket.

12. During gastric probing, remember to frequently palpate the abdomen for excessive distension. Physical manipulation to massage/stimulate the stomach is needed to help break up the stomach contents or bezoars; Hopefully this will allow some material to be removed by gastric lavage.

13. Perform several lavage cycles (> 10) to remove stomach contents and maximize decontamination.