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Lee, Park, Kim, Lee, Ahn, Gil, and Choi: A Case of Activated Charcoal Aspiration Treated by Early and Repeated Bronchoalveolar Lavage
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2012; 72(2): 177-181.

Published online: 29 February 2012

DOI: https://doi.org/10.4046/trd.2012.72.2.177

A Case of Activated Charcoal Aspiration Treated by Early and Repeated Bronchoalveolar Lavage

Han Min Lee, M.D.1, Jae-Seok Park, M.D.1, Jae Yun Kim, M.D.1, Ji Yeon Lee, M.D.2, Byung Kyu Ahn, M.D.2, Hyo-Wook Gil, M.D., Ph.D.1, Jae-Sung Choi, M.D., Ph.D.1

1Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.

2Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea.

Address for correspondence: Jae-Sung Choi, M.D., Ph.D. Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, 23-20, Bongmyeong-dong, Dongnam-gu, Cheonan 330-721, Korea. Phone: 82-41-570-2377, Fax: 82-41-574-5762, cjssch@schmc.ac.kr

Received 5 September 2011       Revised 4 October 2011       Accepted 20 October 2011

Copyright © 2012. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Activated charcoal is an inert substance and it is used in standard therapy in patients with acute intoxication. Charcoal has some side effects such as pulmonary aspiration, gastrointestinal complications, and electrolyte abnormalities. Although aspiration of charcoal is a rare complication, it can cause fatal sequelae. We report a 69-year old man who developed acute respiratory failure associated with charcoal aspiration after management of glyphosate poisoning. The patient was drowsy and suffered severe vomiting during transport to our hospital. On arrival, acute respiratory failure was observed due to charcoal aspiration, but the clinical state was improved with repeated bronchoscopy with a bronchoalveolar lavage (BAL). We presumed that the aspirated charcoal was an important factor in evoking a lung injury. Early bronchoscopy with a BAL might be an effective method for eliminating charcoal from the lung, especially in the case of a large amount of aspiration, and be helpful in decreasing respiratory failure due to charcoal aspiration.

Keywords: Charcoal, Respiratory Aspiration, Respiratory Insufficiency, Bronchoalveolar Lavage, Bronchoscopy

Figures and Tables

Figure 1
Serial change of patient's chest radiogram. (A) Initial x-ray in the emergency room shows an infiltration in left lung, right upper lung and right lower lung. (B) X-ray after bronchoalveolar lavages for three consecutive days shows that the infiltrations in left lower lung, right upper lung and right lower lung were improving. (C) Follow up x-ray at 20th day after charcoal aspiration shows the infiltrations in left lung were almost clear.
trd-72-177-g001
Figure 2
Bronchoscopic findings of patient before and after bronchoalveolar lavage (BAL). (A, B) Black foreign materials, which were thought to be aspirated charcoal, on bronchial mucous membrane at the first visit. (C, D) Cleaned bronchial mucous membrane after BAL procedures. Arrows show charcol. Arrows shows charcol (A, C: carina; B, D: LLL Basal). LLL: left lower lobe.
trd-72-177-g002

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