Difference between revisions of "Ipecac toxicity"

 
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*Occasionally seen used in Munchausen by proxy
 
*Occasionally seen used in Munchausen by proxy
  
==Mechanism of Action==
+
===Mechanism of Action===
 
*[[Vomiting]]
 
*[[Vomiting]]
 
**Immediate: direct irritation of gastric mucosa
 
**Immediate: direct irritation of gastric mucosa
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*Inhibition of protein synthesis in skeletal muscle
 
*Inhibition of protein synthesis in skeletal muscle
  
==Toxic Dose==
+
===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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===Acute===
 
===Acute===
 
*[[Nausea/vomiting]]
 
*[[Nausea/vomiting]]
**Gastritis
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*[[Gastritis]]
[[Mallory-Weiss]] tears
 
*Gastric rupture (rare)
 
 
===Chronic===
 
===Chronic===
 
*[[Dehydration]]
 
*[[Dehydration]]
 
*[[Diarrhea]]
 
*[[Diarrhea]]
*[[Hypokalemia
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*[[Hypokalemia]]
*[[Cardiomyopathy
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*[[Cardiomyopathy]]
*Myopathy ([[weakness]]], hyporeflexia)
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*Myopathy ([[weakness]], hyporeflexia)
 +
 
 +
==Differential Diagnosis==
 +
{{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
+
*Electrolytes, CPK, LDH
 
*[[ECG]]
 
*[[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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 +
 
 +
==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