Severe respiratory failure following charcoal application in a toddler

Charcoal has been commonly used for enteral detoxication with few adverse e ffects. In toddlers charcoal can often be simply applied via a gastric tube . Regurgitation and aspiration is considered a rare event. We report the ca se of a 19-month-old boy who suffered endobronchial charcoal contamination followed by acute airway obstruction and severe respiratory failure despite a commonly used tube placement verification technique. Immediate intubatio n, tracheal suctioning, intravenous bronchodilators, and high frequency osc illatory ventilation (HFOV) were used to control hypercarbia and hypoxia. E ventually charcoal removal by bronchoscopy was successful. Chest X-ray inve stigation did not reflect the true amount of charcoal deposited endobronchi ally at any time. We conclude that gastric tube application of charcoal in children carries a risk of aspiration. This may lead to life-threatening re spiratory failure with the need to provide artificial ventilation and bronc hial lavage. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.