Ipecac toxicity: Difference between revisions
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==Mechanism of Action== | ==Mechanism of Action== | ||
*Vomiting | *[[Vomiting]] | ||
**Immediate: direct irritation of gastric mucosa | **Immediate: direct irritation of gastric mucosa | ||
**Delayed: absorption, stimulation of chemoreceptor trigger zone | **Delayed: absorption, stimulation of chemoreceptor trigger zone | ||
| Line 20: | Line 20: | ||
==Clinical Features== | ==Clinical Features== | ||
===Acute=== | |||
* | *[[Nausea/vomiting]] | ||
* | **Gastritis | ||
** | [[Mallory-Weiss]] tears | ||
*Gastric rupture (rare) | |||
===Chronic=== | |||
*[[Dehydration]] | |||
*[[Diarrhea]] | |||
*[[Hypokalemia | |||
*[[Cardiomyopathy | |||
*Myopathy ([[weakness]]], hyporeflexia) | |||
==Evaluation== | ==Evaluation== | ||
*Emetine can be detected in urine for several weeks | *Emetine can be detected in urine for several weeks | ||
*Electrolytes, BUN/Cr, CPK, LDH | *Electrolytes, BUN/Cr, CPK, LDH | ||
*[[ECG]] | |||
==Management== | ==Management== | ||
Revision as of 01:43, 11 December 2016
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