Ipecac toxicity

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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

Mallory-Weiss tears

  • Gastric rupture (rare)

Chronic

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