Poisoning ipecac

Ipecac, an emetic, contains emetine and cephaeline. It is used in a dose of 15 to 30 mL with 200 to 300 mL of water in drug overdosage and certain cases of poisoning. Ipecac may fail to exert its emetic effects on an empty stomach. Ipecac causes vomiting by irritating the stomach... 

The following guidelines have been developed for the use of ipecac Cephaelis ipecacuanha), one of the most common botanical emetics used, but are applicable to any botanical being used for emetic purposes in the case of poisonings. Ipecac (and other emetics) should not be used unless directed by a qualified healthcare professional (physician, poison control center, or other professional), and should not be used if ... 

Ipecac is prepared from the dried roots and rhizomes of Cephaelis ipecacuanha (Brot.) A. Rich, and contains the alkaloids emetine [483-18-1] (17) and cephaeJine [483-17-0] (18) in a ratio between 2 1 and 4 1. It has been used extensively in cough preparations and is beheved to act by gastric reflex stimulation. Toxic effects include vomiting, irritation of the gastrointestinal tract, and cardiac arrhythmias (19). Ipecac symp is available over-the-counter in the United States only in 30-mL containers for use as an emetic in treating poisonings. 

Ms. Jerkins has four children and wants to keep syrup of ipecac available in case of accidental poisoning. Discuss the information you fed that Ms. Jerkins should know before die administers this drug. 

No studies so far have shown that the use of ipecac in the management of acute oral poisoning modifies patient s clinical outcome and because they can lead to complications and prolonged hospital course, the ipecac carries no role in the routine toxicology management. There may be some acceptable benefit-to-risk in using ipecac but only in rare situations, as found in consensus guideline prepared by the American Association of Poison Control Centers. 

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. 

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. 

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. 

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-... 

Emetics are used to induce vomiting and are frequently administered to help empty the stomach of poisons or ingested toxins. The two primary emetics are apo-morphine and ipecac. Both agents seem to work by stimulating the medullary emetic center, and ipecac also exerts a direct emetic effect on the stomach. 

In the U.S., syrup of ipecac has long been valued as an emetic OTC agent in the treatment of poisonings, and it has been the primary form of decontamination in pediatric cases, both at home and in health-care facilities (see Chapter 55). 

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. 

Syrup of ipecac (use to induce vomiting if advised by the poison control center)... 

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. 

The root of the ipecac is commonly used as an expectorant in the treatment of bronchitis, croup, asthma amoebacide and whooping cough, as an emetic in cases of poisoning, and an amoebacide in amoebic dysentery. It has appeared in the Japanese Pharmacopoeia (2001) as ipecac, powdered ipecac and ipecac S)nxip [6]. The ipecac is rich in isoquinoline alkaloids such as emetine, cephaeline, psychotrine. 

For treatment of oral poisoning, administration of syrup of ipecac is indicated, followed by gastric... 

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. 

Numerous emetics have been advocated in the past for the treatment of the poisoned patient. Past emetics have included apomorphine, egg whites, saltwater, copper sulfate, and household dish-washing liquid. However, the use of these agents is fraught with ineffectiveness and potential harm to the patient. The only acceptable emetic that may be considered is syrup of ipecac. 

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