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ASK CRN Column Editor: Claire Callahan, RD, CS Question Recently a continuous ambulatory peritoneal dialysis patient reported using activated char- coal to relieve gas symptoms. Although this product is used in drug overdoses and for colostomy bags, should there be concern about the absorption of medications and nutrients in this patient, and what are acceptable alternative products on the market? Answer From Julie Prinsen, RD, Ohio Valley Dialysis Center and WSKC, Dialysis Services, Evansville, IN: Activated charcoal is used as an emergency treatment in poisoning of most drugs and chemicals. Activating the charcoal creates a fine network of pores, which increases its absorptive properties. Actual studies of specific drugs ab- sorbed, however, are limited. Studies have proven that activated charcoal will absorb mef- enamic acid, or Ponstel which is an analgesic agent,’ nortriptyline, or Pamelor which is an antidepressant,2 propoxyphene, or Darvon which is a narcotic analgesic agent,3 and urso- diol, or Actigall used for gallbladder stone dissolution4 Studies have also shown that acti- vated charcoal will absorb the following: (1) acetaminophen, which is used in many pain relievers; (2) digoxin, used to strengthen and slow the heart beat, and (3) theophylline, used in many drugs as a bronchodilator.5 Studies showing absorption of renal specific medications were not found. However, because o 2996 by the National Kidney Foundation, Inc. 1051-2276/96/0604-0010$03.00/O activated charcoal has such a large surface area, logic would tell us that there is a great probabil- ity that renal specific medications are similarly absorbed. Therefore, it would be prudent to try to avoid using it if at all possible. Finding the source of the gas and trying to eliminate it should be the medical team’s objec- tive. Chewing gum and stress, along with poor fitting dentures can contribute to flatulence by increasing the nitrogen content in the gut6 Gas and odors can also arise from alcoholic bever- ages and foods such as dried beans, onions, green peppers, cabbage, turnips and beets. Avoiding milk, for those who are lactase defi- cient, will also decrease the amount of flatus in the gut. Accurate diet histories, along with dietary counseling in avoiding the above mentioned foods, are the best weapon in avoiding the need for activated charcoal and its related problems. References 1. Allen EM, Buss DC, Wtlhams J, et al: The effect of activated charcoal on mouse sleep times induced by intrave- nously admunstered hypnotics. Biopharm Drug Drspos 7:421- 429,1986 2. Karkkainen S, Neuvonen PJ: Pharmacokinencs of amr- triptyline influenced by oral charcoal and urine pH. Int J Chn Pharmacol Ther Toxicol24:326-332, 1986 3. Karkkainen S, Neuvonen PJ: Effect of oral charcoal and urine pH on dextropoxphene pharmacokinencs. Int J Clm Pharmacol Ther Toxic01 23:219-225, 1985 4. Bachrach WH, Hofmann AF: Ursodeoxycholic actd in the treatment of cholesterol cholelithtases (Part I). Dig Dis Sci 27:737-761,1982 5. Chyka PA, Holley JE, Mandrel1 TD, et al: Correlatton of drug pharmacokmetlcs and effectweness of multiple dose activated charcoal therapy. Ann Emerg Med 25356-362, 1995 6. Van Ness, Chattau: Flatulence: Pathophysiology and treatment. Am Fam Physician 31’19%208,1985 236 ]oumal ofRenal Nutrition, Vol 6, No 4 (October), 1996: p 236

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Column Editor: Claire Callahan, RD, CS

Question

Recently a continuous ambulatory peritoneal dialysis patient reported using activated char- coal to relieve gas symptoms. Although this product is used in drug overdoses and for colostomy bags, should there be concern about the absorption of medications and nutrients in this patient, and what are acceptable alternative products on the market?

Answer

From Julie Prinsen, RD, Ohio Valley Dialysis Center and WSKC, Dialysis Services, Evansville, IN: Activated charcoal is used as an emergency treatment in poisoning of most drugs and chemicals. Activating the charcoal creates a fine network of pores, which increases its absorptive properties. Actual studies of specific drugs ab- sorbed, however, are limited. Studies have proven that activated charcoal will absorb mef- enamic acid, or Ponstel which is an analgesic agent,’ nortriptyline, or Pamelor which is an antidepressant,2 propoxyphene, or Darvon which is a narcotic analgesic agent,3 and urso- diol, or Actigall used for gallbladder stone dissolution4 Studies have also shown that acti- vated charcoal will absorb the following: (1) acetaminophen, which is used in many pain relievers; (2) digoxin, used to strengthen and slow the heart beat, and (3) theophylline, used in many drugs as a bronchodilator.5

Studies showing absorption of renal specific medications were not found. However, because

o 2996 by the National Kidney Foundation, Inc. 1051-2276/96/0604-0010$03.00/O

activated charcoal has such a large surface area, logic would tell us that there is a great probabil- ity that renal specific medications are similarly absorbed. Therefore, it would be prudent to try to avoid using it if at all possible.

Finding the source of the gas and trying to eliminate it should be the medical team’s objec- tive. Chewing gum and stress, along with poor fitting dentures can contribute to flatulence by increasing the nitrogen content in the gut6 Gas and odors can also arise from alcoholic bever- ages and foods such as dried beans, onions, green peppers, cabbage, turnips and beets. Avoiding milk, for those who are lactase defi- cient, will also decrease the amount of flatus in the gut.

Accurate diet histories, along with dietary counseling in avoiding the above mentioned foods, are the best weapon in avoiding the need for activated charcoal and its related problems.

References 1. Allen EM, Buss DC, Wtlhams J, et al: The effect of

activated charcoal on mouse sleep times induced by intrave- nously admunstered hypnotics. Biopharm Drug Drspos 7:421- 429,1986

2. Karkkainen S, Neuvonen PJ: Pharmacokinencs of amr- triptyline influenced by oral charcoal and urine pH. Int J Chn Pharmacol Ther Toxicol24:326-332, 1986

3. Karkkainen S, Neuvonen PJ: Effect of oral charcoal and urine pH on dextropoxphene pharmacokinencs. Int J Clm Pharmacol Ther Toxic01 23:219-225, 1985

4. Bachrach WH, Hofmann AF: Ursodeoxycholic actd in the treatment of cholesterol cholelithtases (Part I). Dig Dis Sci 27:737-761,1982

5. Chyka PA, Holley JE, Mandrel1 TD, et al: Correlatton of drug pharmacokmetlcs and effectweness of multiple dose activated charcoal therapy. Ann Emerg Med 25356-362, 1995

6. Van Ness, Chattau: Flatulence: Pathophysiology and treatment. Am Fam Physician 31’19%208,1985

236 ]oumal ofRenal Nutrition, Vol 6, No 4 (October), 1996: p 236