Ipecac-induced emesis

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. 

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. 

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. 

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... 

In cases of ingestion, ipecac-induced emesis is not recommended. Activated charcoal slurry with or without saline cathartic or sorbitol can be given in cases of oral exposures. Exposed skin should be decontaminated by repeated washing with soap. Exposed eyes should be irrigated with copious amounts of water at room temperature for at least 15 min. 

In the patient who presents with seizures, airway protection and seizure control are primary goals. Disturbances in cardiac rhythm or function also require immediate attention. Ipecac-induced emesis is contraindicated due to the risk of seizures and the resulting potential for aspiration. Gastrointestinal decontamination via administration of activated charcoal should be considered for substantial recent ingestions. Pyridoxine is administered intravenously to all symptomatic and potentially serious asymptomatic overdoses as it provides rapid relief or prevention of severe toxicity, including seizures. The pyridoxine dosage is... 

Emesis Ipecac-induced emesis is not recommended because of the potential for CNS depression and seizures. 

If ingested, syrup of ipecac-induced emesis should be avoided since seizures or lethargy can occur rapidly. Activated charcoal should be administered. Seizures should be treated with diazepam or phenytion. Atropine can be used to control signs of excess parasympathetic stimulation. If hypotension does not respond to intravenous fluids, dopamine or norepinephrine may be indicated. Antacids should be avoided since nicotine has greater absorption in an alkaline media. Vital signs and level of consciousness should be monitored closely. Further care is... 

Wax PM, Cobaugh DJ, and Lawrence RA (1999) Should home ipecac-induced emesis be routinely recommended in the management of toxic berry ingestion Veterinary and Human Toxicology 41(6) 394-397. 

The current consensus is that syrup of ipecac should not be administered routinely in the management of poisoned patients. In studies with various marker substances, the beneficial effects of ipecac-induced emesis were highly variable and diminished rapidly with time. In addition, initial use of ipecac in fact may be counterproductive by reducing the efficacy of other, later, and presumably more effective treatments such as use of activated charcoal, oral antidotes, and whole bowel irrigation (WBI). Ipecac may be indicated when it can be administered to conscious, alert patients within 60 minutes of poisoning. 

A. Activated charcoal is used orally after an ingestion to limit drug or toxin absorption. Although traditionally given after the stomach has been emptied by ipecac-induced emesis or gastric lavage, it is now more common practice and studies support that it may be used alone for most ingestions. Use in the home after a childhood exposure is controversial. 

I. Pharmacology. Ipecac syrup is a mixture of plant-derived alkaloids, principally emetine and cephaeline, that produce emesis by direct irritation of the stomach and by stimulation of the central ohemoreceptor trigger zone. Vomiting occurs in 90% of patients, usually within 20-30 minutes. Depending on the time after ingestion of the toxin, ipecac-induced emesis removes 15-50% of the stomach contents. There is no evidence that the use of ipecac improves the clinical outcome of poisoned patients. 

A follow-up study with 146 patients that had been administered ipecac syrup indicated that within 4 hours after ipecac-induced emesis, 33.6% had no symptoms and 17.1% experienced protracted emesis. Incidences of diarrhea and atypical lethargy were higher after ipecac-induced emesis than in patients not receiving ipecac syrup (Czajka and Russell 1985). 

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