Ipecac, syrup

Prescribed is 15 mL of 1.5% ipecac syrup. Available is 30 mL ipecac 1.5% syrup. The nurse administers... 

Treatment — As with other toxin therapies, treatment is limited mainly to supportive management. Mechanical respiration support may be required in severe cases. An antitoxin has shown success in animal models, but no human data are available to date. No vaccine has been developed. Induction of vomiting may prove to be useful as part of the treatment program. Ipecac syrup is a good emetic that could be used to induce vomiting.3... 

No vaccine has been developed Induction of vomiting may prove to useful Ipecac syrup can induce vomiting... 

Digoxin Immune Fab (Digibind, DigiFab) Ipecac Syrup (OTC)... 

American Academy of Clinical Toxicology and European Association of Poisons Centers and Chnical Toxicologists. Position paper ipecac syrup. J Toxicol Clin Toxicol 2004 42(2) 133-43. 

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

Manoguerra AS, Cobaugh DJ and members of consensus panel. Guideline on the use of ipecac syrup in the out-of-hospital management of ingested poisons. J Toxicol Clin Toxicol 2005 43(1) 1-10. 

Nenvonen PJ, Vartiainen M, Tokola O. Comparison of activated charcoal and ipecac syrup in prevention of drug absorption. Eur J Clin Pharmacol 1983 24 557-62. 

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. 

Cardiotoxicity may occur if ipecac syrup is not vomited (noted as hypotension, tachycardia, precordial chest pain, pulmonary congestion, dyspnea, ventricular tachycardia and fibrillation, cardiacarrest). 

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-... 

When the heart can no longer pump an adequate supply of blood to meet the metabolic needs of the tissues or in relation to venous return, cardiac failure may ensue. The causes of cardiac failure are complex, but stem from mechanical abnormalities (e.g., pericardial tamponade), myocardial failure (e.g., cardiomyopathy and inflammation), and arrhythmias. In high-output failure, the cardiac output, which may be normal or even higher than normal, is not sufficient to meet the metabolic requirement of the body. Cardiac failure may predispose a patient to congestive heart failure, which is a state of circulatory congestion. Toxic injury, caused by agents such as doxorubicin, the alkaloid emetine in ipecac syrup, cocaine, or ethyl alcohol, is another way by which the functional integrity of the heart may also be compromised. 

Note The most commonly used emetics are ipecac and apomorphine. 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 there is central nervous system depression or ingestion of certain volatile hydrocarbons and caustic substances. Ipecac syrup is prepared from the dried rhizome and roots of Cephaelis ipecacuanha or of C. accuminata, plants from Brazil and Central America, in which the alkaloid emetine is its active principal ingredient. 

Ipecac, which is a mixture of the alcohol-soluble alkaloids from the underground parts of the South American plant, C. ipecacuanha, is used almost solely as the U.S.P. ipecac syrup. 

Emergency medical personnel should be contacted immediately if an overdose is suspected. If a poison control center suspects a dextromethorphan overdose, induced vomiting may be recommended. The usual home treatment involves the administration of ipecac syrup to induce vomiting. 

Apart from specific antidotes (if they exist), the treatment of poisonings also calls for symptomatic measures (control of blood pressure and blood electrolytes monitoring of cardiac and respiratory function prevention of toxin absorption by activated charcoal). An important step is early emptying of the stomach by gastric lavage and, if necessary, administration of an osmotic laxative. Use of emetics (saturated NaCl solution, ipecac syrup, apomorphine s.c.) is inadvisable. 

Krenzelok, E.P., McGuigian, M., Lheur, P. (1997). Position statement ipecac syrup. American Academy of Clinical Toxicology European Association of Poisons Centres and Clinical Toxicologists. J. Toxicol. Clin. Toxicol. 35 699-709. 

Position paper Ipecac syrup. J Tox/co/ Clin Toxicol. 2004 42 133-143... 

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... 

Plasma hexachlorophene levels have not been demonstrated to correlate well with clinical effects. Hexachlorophene may cause seizures. The risk of seizures during emesis may preclude the use of ipecac syrup. Charcoal slurry, aqueous or mixed with saline cathartic or sorbitol, should be administered. The usual charcoal dose is 30-100 g in adults and 15-30 g in children (1 or 2 g kg in infants). If seizures cannot be controlled with diazepam or they recur, phenytoin or... 

There are several potential causes for segmental necrosis of muscle fiber. The cause of this type of necrosis is not well understood but could be due to effects on the plasma membrane or the outer boundary of the muscle fiber. Aminocaproic acid (an antifibrinolytic medication used in the treatment of a subarachnoid hemorrhage), clofibrate (used to treat hyperlipedemia), emetine (found in ipecac syrup), cardiac glycosides, heroin, and phencyclidine have been associated with necrotizing myopathies. 

Pharmacological method is by administering an emetic. The mostly commonly use emetic is Ipecac syrup. Ipecac stimulates the CTZ in the medulla and acts directly on the gastric mucosa. However, Ipecac is somewhat controversial. Administer Ipecac with at least 8 ounces of water or juice. Do not use milk or carbonated beverages. Administer Ipecac again if vomiting does not occur in 20 minutes. If vomiting still does not occur, then administer activated charcoal. 

The use of ipecac syrup, gastric lavage, and cathartics has fallen out of favor as routine therapies, whereas activated charcoal and whole-bowel irrigation are still useful for the gastric decontamination of appropriate patients. 

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