Poisoning ipecac syrup

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-... 

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. 

Ipecac syrup, a nonprescription drug, has been used in the United States for the past 50 years as a means to induce vomiting for the treatment of ingested poisons. Despite its widespread use, concerns about its effectiveness and safety have been raised recently. An expert panel of North American and European toxicologists concluded that its routine use in the emergency department should be abandoned. The American Academy of Pediatrics issued a policy statement in 2003 that indicated that ipecac syrup was no longer to be used rou-... 

There is no accepted specific prehospital care for calcium channel blocker poisoning except to summon an ambulance for symptomatic patients. Ipecac syrup should be avoided due to the risks of seizures and coma. The therapeutic options for the management of calcium channel blocker poisoning include supportive care, gastric decontamination, and adjunctive therapy for the cardiovascular and metabolic effects. Supportive care consists of airway protection, ventilatory... 

Krenzelok EP, McGuigan M, Lheur P. American Academy of Clinical Toxicology, European Association of Poison Centres and Clinical Toxicologists. Position statement Ipecac syrup. J Toxicol Clin Toxicol 1997 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 syrup [6]. The ipecac is rich in isoquinoline alkaloids such as emetine, cephaeline, psychotrine,... 

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. 

Emetine (and synthetic dehydroemetine) are employed primarily in developing countries from the treatment of amoebic dysentery. Ipecac root products (primarily ipecac syrup), which contain mainly emetine and cephaeline are widely used as emetics in cases of poisoning. 

Ipecac Syrup U.S.P. is widely used as a domestic emetic for children, but it should not be used if the swallowed poisons arc alkalis, strong acids, strychnine, petroleum distillates, and cleaning fluids. 

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. 

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). 

---