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Ipecac
From WikEM
Contents
Background
- Rapidly acting emetic agent
- Derived from the ipecacuanha plant
- Often abused by adults with eating disorders
- Occasionally seen used in Munchausen by proxy
Mechanism of Action
- Vomiting
- Immediate: direct irritation of gastric mucosa
- Delayed: absorption, stimulation of chemoreceptor trigger zone
- Inhibition of protein synthesis in skeletal muscle
Toxic Dose
- Acute
- As little as 10 mL of the potent fluid extract can cause death
- 120 mL of syrup of ipecac unlikely to cause severe toxicity
- Chronic
- Slow elimination of emetine causes cumulative toxicity
- Daily ingestion of 90-120 mL of syrup for several months can cause cardiomyopathy and death
Clinical Features
Acute
- Nausea/vomiting
- Gastritis
Mallory-Weiss tears
- Gastric rupture (rare)
Chronic
- Dehydration
- Diarrhea
- Hypokalemia
- Cardiomyopathy
- Myopathy (weakness, hyporeflexia)
Evaluation
- Emetine can be detected in urine for several weeks
- Electrolytes, BUN/Cr, CPK, LDH
- ECG
Management
- Administer activated charcoal
- IV fluids as needed
- Potassium repletion as needed
- Diuretics/pressors for cardiomyopathy and CHF
- No specific antidote
References
- Olson, K. Poisoning and Drug Overdose Clinical Manual. 2004
