Ipecac emesis

The most widely used emetic is syrup of ipecac, containing the alkaloids, emetine and cq haeline. Emetine induces vomiting by activation of sensory neurons in the vagus and sympathetic nerves to the stomach and centrally in the medulla, possibly at the CTZ. The release of serotonin and SP may be involved as 5-HT3 and NKi receptor antagonists prevent emesis induced... 

It is useless for a non-toxic agent. There are few adequate studies on the matter with the limitation of using undifferentiated poisoned subjects and hence the value for lavage and its outcome are controversial. There is some evidence to suggest that it is effective and better than ipecac-induced emesis. 

Krenzelok EP. Ipecac syrup-induced emesis no evidence of benefit. J Toxicol Cfin Toxicol 2005 43(1) 11-2. 

Tandberg D, Diven BG, McLeod JW. Ipecac-induced emesis versus gastric lavage a controlled study in normal adults. Am J Emerg Med 1986 4 205-9. 

Tandberg D, Murphy LC. The knee-chest position does not improve the efficacy of ipecac-induced emesis. Am J Emerg Med 1989 7(3) 267-70. 

Induce emesis with syrup of ipecac if victim is conscious and has not ingested acids, alkali, hydrocarbons, or petroleum distillates... 

The most commonly used emetics are ipecac and apo-morphine. Induced emesis is the preferred means of emptying the stomach in awake patients who have ingested a toxic substance or have recently taken a drug overdose. Emesis should not be induced if the patient has central nervous system depression or has ingested certain volatile hydrocarbons and caustic substances. 

Ipecac syrup is prepared from the dried rhizome and roots of Cephaelis ipecacuanha or Cephaelis acuminata, plants from Brazil and Central America that have the alkaloid emetine as their active principal ingredient. It acts directly on the CTZ and also indirectly by irritating the gastric mucosa. Ipecac is cardiotoxic if absorbed and can cause cardiac conduction disturbances, atrial fibrillation, or fatal myocarditis. If emesis does not occur, gastric lavage using a nasogastric tube must be performed. 

Emesis can be induced with ipecac syrup (never extract of ipecac), and this method was previously used to treat some childhood ingestions at home under telephone supervision of a physician or poison control center personnel. However, the risks involved with inappropriate use outweighed the unproven benefits, and this treatment is rarely used in the home or hospital. Ipecac should not be used if the suspected intoxicant is a corrosive agent, a petroleum distillate, or a rapid-... 

Ipecac, the root of a Brazilian plant, contains several alkaloids of which two, emetine and cephaeline, produce local irritation and nausea and emesis, by central and local action, without danger of side effects. 

The most useful household emetic is syrup of ipecac (not ipecac fluid extract, which is 14 times more potent and may cause fatalities). Syrup of ipecac is available in 0.5- and 1-fluid ounce containers (approximately 15 and 30 ml), which may be purchased without prescription. The drug can be given orally, but it takes 15 to 30 min to produce emesis this compares favorably with the time usually required for adequate gastric lavage. The oral dose is 15 ml in children from 6 months to 12 years of age and 30 ml in older children and adults. Because emesis may not occur when the stomach is empty, the administration of ipecac should be followed by a drink of water. 

During the period from 1983 to 1991 there has been a continual decline in the use of syrup of ipecac to induce emesis. Ipecac contains a number of plant alkaloids including emetine. It induces emesis through stimulation of the chemoreceptor trigger zone in the brain and local irritation of the gastrointestinal tract. The latency period for... 

Emesis with syrup of ipecac has been reeommended for children with a history of accidental ingestion of small amounts, more than a grain or two , if it ean be administered within 1 h from the time of ingestion (Katona and Wason, 1989). 

Tenenbein, M., Cohen, S., Sitar, D.S. (1987). Efficacy of ipecac-induced emesis, orogastric lavage, and activated charcoal for acute drug overdose. Ann. Emerg. Med. 16 838 1. 

Gastric lavage and activated charcoal are considered to be effective decontamination measures, whereas ipecac-induced emesis should be avoided after massive ingestion, because of the risk of seizures. Aggressive use of benzodiazepine is a reasonable first choice to treat associated involuntary movements, tremor, hyperactivity, and agitation. Chlorpromazine or haloperidol can also be used, especially for serious, life-threatening symptoms, including hypertensive crises and severe hyperthermia, and labetalol or sodium nitroprusside are reasonable choices for rapid stabilization of blood pressure. 

Gastrointestinal decontamination with multiple dose activated charcoal is recommended for recent acute ingestion [86] and may be most effective (along with cathartics) for enteric coated salicylate preparations. Induction of emesis with ipecac is no longer recommended [86]. Alkalinization of the urine is recommended for patients with preserved renal function who are unsuitable or do not meet criteria for dialysis [87] and may be of benefit during preparation for hemodialysis. 

Dermal decontamination should be accomplished by repeated washing with soap. Leather clothing can absorb benomyl any contaminated leather clothing should therefore be discarded. Exposed eyes should be irrigated with copious amounts of room-temperature water for at least 15 min. Emesis can be induced in cases of recent ingestion. In such cases, ipecac can be used to induce emesis. Emesis is not encouraged if the patient is comatose or convulsing. Activated charcoal slurry with or without saline cathartic and sorbitol may be used. 

Treatment is supportive following exposure. The victim should be monitored for CNS and respiratory depression, metabolic acidosis, and hypotension. Ipecac-induced emesis is not recommended. On ocular exposure, the eyes should be irrigated for at least 15 min with tepid water. On dermal exposure, the exposed area should be washed with soap and water. If irritation, pain, swelling, lacrimation, or... 

Upon exposure by ingestion, where corrosive injury is absent, the decontamination to prevent further absorption may be achieved by use of activated charcoal. Emesis by syrup of ipecac may be considered, but not preferred. Next, milk should be given to drink. Gastric lavage and emesis are contraindicated in the presence of esophageal injury. In the case of dermal exposure, the poison should be removed by washing the affected skin or mucous membrane with copious amounts of water for at least 15 min. 

Chlorophenoxy compounds are moderately irritating to skin. In case of dermal or eye exposure, the contaminated area should be bathed or flushed with copious amounts of water for 15 min and if irritation persists a physician should be contacted. Ingestion of substantial amounts of these chemicals results in spontaneous emesis. If the patient is fully alert and there are no apparent signs of emesis, emesis is induced with syrup of ipecac (adults, 30 ml children <12 years, 15 ml), followed by one to two glasses of water. In order to limit the absorption of the herbicide in the gut, 30-50 g of activated charcoal is administered in 6-8 ounces of water. Severe intoxication with chlorophenoxy compounds may result in renal failure. To avoid... 

Induction of emesis depends on product toxicity, quantity, time since exposure, patient s weight, and the presence of symptoms. Cationic surfactants, perborates, and substantial ingestion of essential oils may benefit by administration of syrup of ipecac. Syrup of ipecac can be used in hydrocarbon ingestion only if the total dose of hydrocarbons exceeds 1 or 2 ml kg... 

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