Contraindications of activated charcoal include:

• A. Altered mental status and ingestion of acids or alkalis
• B. Mild dehydration
• C. Ingestion of water
• D. Hypotension

Answer: (A)

Activated charcoal can bind many toxins in the gut, but it must be used only when the patient can protect the airway and when the substance is amenable to adsorption. Altered mental status means the patient may not swallow safely or keep the airway clear, so charcoal poses a real risk of aspiration and is not appropriate. Ingestions of acids or alkalis are caustic and cause tissue injury; charcoal does not effectively neutralize or adsorb these substances, and giving it can delay more appropriate treatment while offering little benefit. Other situations like mild dehydration, ingestion of water, or even hypotension are not absolute reasons to withhold treatment on their own, provided airway protection and overall stability are managed.