Difference between revisions of "Ipecac toxicity"

(Created page with "==Background== *Rapidly acting emetic agent *Derived from the ipecacuanha plant *Often abused by adults with eating disorders *Occasionally seen used in Munchausen by proxy =...")
 
 
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*Occasionally seen used in Munchausen by proxy
 
*Occasionally seen used in Munchausen by proxy
  
==Mechanism of Action==
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===Mechanism of Action===
*Vomiting
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*[[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
 
*Inhibition of protein synthesis in skeletal muscle
 
*Inhibition of protein synthesis in skeletal muscle
  
==Toxic Dose==
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===Toxic Dose===
 
*Acute
 
*Acute
 
**As little as 10 mL of the potent fluid extract can cause death
 
**As little as 10 mL of the potent fluid extract can cause death
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*Chronic
 
*Chronic
 
**Slow elimination of emetine causes cumulative toxicity
 
**Slow elimination of emetine causes cumulative toxicity
**Daily ingestion of 90-120 mL of syrup can cause cardiomyopathy and death
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**Daily ingestion of 90-120 mL of syrup for several months can cause cardiomyopathy and death
  
 
==Clinical Features==
 
==Clinical Features==
*Acute
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===Acute===
**Nausea, vomiting, gastritis, Mallory-Weiss tears, and gastric rupture (rare)
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*[[Nausea/vomiting]]
*Chronic
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*[[Gastritis]]
**Dehydration, hypokalemia, diarrhea, cardiomyopathy, myopathy (weakness, hyporeflexia)
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===Chronic===
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*[[Dehydration]]
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*[[Diarrhea]]
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*[[Hypokalemia]]
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*[[Cardiomyopathy]]
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*Myopathy ([[weakness]], hyporeflexia)
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==Differential Diagnosis==
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{{Nausea and vomiting DDX}}
  
 
==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, ECG
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*Electrolytes, CPK, LDH
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*[[ECG]]
  
 
==Management==
 
==Management==
*Administer activated charcoal
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*No specific antidote exists
*IV fluids as needed
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*Supportive care is mainstay of treatment
*Potassium repletion as needed
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**[[IV fluids]]
*Diuretics/pressors for cardiomyopathy and CHF
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**[[Electrolyte repletion]]
*No specific antidote
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 +
==Disposition==
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==See Also==
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 +
 
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==External Links==
 +
 
  
 
==References==
 
==References==
*Olson, K. Poisoning and Drug Overdose Clinical Manual. 2004
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<references/>
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[[Category:Toxicology]]
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[[Category:GI]]

Latest revision as of 21:46, 29 September 2019

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

Chronic

Differential Diagnosis

Nausea and vomiting

Critical

Emergent

Nonemergent

Evaluation

  • Emetine can be detected in urine for several weeks
  • Electrolytes, CPK, LDH
  • ECG

Management

Disposition

See Also

External Links

References