Ipecac--three centuries of controversy.
Explore the source record for details and available documents.
Brazil↗
SEARCH · Search PubMed
Results for “IPECAC”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Ipecac, Indian turnip, and sassafras: a sampling of American Indian medicine.
Explore the source record for details and available documents.
Complementary Therapies↗
Gastric emptying. Risk versus benefit in the treatment of acute poisoning.
This review examines the various clinical options used to elicit gastric emptying, viz. drug-induced emesis, mechanical pharyngeal stimulation, gastric lavage, and catharsis. Apomorphine and syrup of ipecac are the 2 drugs most frequently used for induction of emesis. Both agents act centrally and, in addition, syrup of ipecac has a peripheral action. Toxins ingested or foods previously eaten may inhibit or enhance emetic action by interfering with mediating and conducting mechanisms. Studies indicate that both syrup of ipecac and apomorphine are similarly effective in inducing emesis; however, apomorphine has a shorter reaction time compared with syrup of ipecac. There are more risks involved with the use of apomorphine, since it causes central nervous system and respiratory depression. Syrup of ipecac has been shown to be relatively safe when used in its recommended dosage for emesis. However, several toxicities have been reported with the use of the fluid extract of ipecac. Emesis is contraindicated in patients who are obtunded or comatose, and in patients who have ingested stimulants, some hydrocarbons, or corrosives. Mechanical pharyngeal stimulation is a simple method of inducing emesis; however, it is often unsuccessful and rarely recovers a significant portion of the gastric contents. Gastric lavage is a procedure which has been relied upon for over a century. Its effectiveness is dependent on the nature, form, and dosage of the poison, latency between time of ingestion and lavage, and technique. In clinical experiments studying gastric lavage, it has been noted that the procedure is most beneficial 1 to 2 hours postingestion for the majority of poison ingestions. Lavage also provides an excellent route for activated charcoal and selected antidotes. Gastric lavage may pose several risks to the patient, including obstruction and contamination of the airways and oesophageal damage. Contraindications for gastric lavage are similar to those for emesis except that it may be safer to use in obtunded, comatose, or uncooperative patients. Cathartics used during initial poisoning therapy are usually the saline cathartics. They elicit an osmotic reaction in the small intestine which results in increased intraluminal fluid bulk, hyperperistalsis, and subsequent propulsion of contents. Cathartics have also been shown to stimulate the secretion of cholecystokinin, which is thought to have similar effects on the intestine. Cathartics have not been shown to significantly enhance drug elimination from the gastrointestinal tract.(ABSTRACT TRUNCATED AT 400 WORDS)
Cathartics↗
Toxic exposures and ingestions in Honolulu: I. A prospective pediatric ED cohort; II. A prospective poison center cohort.
Poisonings and toxic exposures are a frequent cause of preventable morbidity in children requiring emergency care. Ingestions and toxic substance exposures were studied in two prospective cohorts in Hawaii to examine the epidemiology of these events in this community in order to assess the effectiveness of current poison prevention practices and to identify additional measures to further prevent and reduce morbidity and mortality. During a 12-month period ending on 11/30/88, data were collected on 286 pediatric patients visiting a pediatric ED with an ingestion or a toxic substance exposure. Most of the younger children were males with unintentional incidents. Most of the adolescents were females with intentional ingestions. Syrup of ipecac was given in 16% of the patients. When given at home, ipecac was given an average of 1.3 hours after an ingestion. Activated charcoal was given to 32% of the patients. During a 13-month period ending 1/31/90, 14,408 phone calls to the Hawaii Poison Center were analyzed. Twenty-six percent of the callers had ipecac at home. Sixty-eight percent of callers with acute ingestions claimed to have called within 30 minutes of the ingestion, and 77% claimed to have called within 60 minutes of the ingestion. Of those calling within 60 minutes, 36% had ipecac at home. Although ipecac is widely recommended as a pre-hospital intervention, it use is limited owing to unavailability in the home and the short period of time during which it must be given. Since the dispensing of pharmaceuticals in limited quantities and in childproof containers began, it appears that other measures to further reduce morbidity and mortality owing to poisonings have had less additional effect. It appears that serious morbidity and mortality from poisonings in this cohort were uncommon.
Academic Medical Centers↗
Prevention of childhood poisoning: efficacy of an educational program carried out in an emergency clinic.
For many inner-city families, the emergency clinic is the most frequent and sometimes the only point of contact with medical services. We hypothesized that this setting could serve as an opportunity to direct a health promotion at a population that might not receive such a message elsewhere. The objectives of the program were (1) to remind parents of the telephone number of the Massachusetts Poison Center, (2) to ensure that parents have ipecac for use in an emergency, and (3) to counsel parents on how to use ipecac. Of 403 families recruited from the emergency clinic and divided randomly into intervention and nonintervention groups, 262 families completed the follow-up interview 6 months later (65%). Results showed that 68% of intervention families compared with 42% of control families reported ipecac storage at follow-up (chi 2 = 7.65, P = .005) and that 40% of intervention families v 25% of control families reported familiarity with the use of ipecac (chi 2 = 4.04, P = .04). Accessibility to the poison center's telephone number was reported by 62% of intervention families and by 49% of control families (chi 2 = 4.60, P = .13). Finally, 42% of intervention families v 25% of control families reported that they had a sticker on their phone with the number of the poison center on it (chi 2 = 4.60, P = .03). Our results suggest that a brief intervention, even in an emergency clinic, can introduce the topic of poisoning prevention to families and can encourage the storage of syrup of ipecac in the home.
Child, Preschool↗
Emergency treatment of petroleum distillate and turpentine ingestion.
A comparative study was made of pulmonary complications following the use of ipecac syrup and gastric lavage for hydrocarbon ingestion. The selected 255 patients had chest radiography when first seen and again two to five days later. Of these patients 74 or 29% had been treated with ipecac syrup, 41 or 16% by gastric lavage. On follow-up radiographs 19% of the ipecac-treated group were unchanged or worsened, compared with 39% of the lavage group, suggesting that pneumonitis was significantly less severe in the ipecac-treated patients. Use of ipecac is preferred over gastric lavage for alert patients who have ingested an excessive amount of hydrocarbon.
Child↗
Pilot evaluation of instructing parents of newborns about poison prevention strategies.
Providing new parents with both written and verbal information about poisons and with syrup of ipecac appeared to be successful when distributed at discharge of their normal newborns. New parents who received neither information nor ipecac served as controls. Distribution occurred during a nine-month period, which was followed after an interval of three months by a four-month evaluation period. The average (+/- SD) time between infant poison exposures and parent telephone calls to the statewide poison center during the evaluation period was 5 +/- 3 minutes for the subjects and 12 +/- 4 for age-matched and socioeconomically matched controls. Both groups had similar frequencies of potentially dangerous exposures for which syrup of ipecac was recommended. Subject parents appeared to have homes which in various respects were significantly more child-safe than those of the controls. Significantly more control homes contained syrup of ipecac after the exposures than before (77% vs 41%).
Health Education↗
Surveillance of loperamide ingestions: an analysis of 216 poison center reports.
BACKGROUND: Loperamide was approved for nonprescription use in 1988. While efficacy is well documented, there are few data on loperamide overdose and management. METHODS: Eight poison centers participated in a prospective study enrolling 216 patients. RESULTS: Where the amount ingested was known, it ranged from 0.03 to 0.94 mg/kg. One- to 3-year-olds were involved in 57.9% of ingestions. Ingestion was unintentional in 182 cases (84.3%), including 59 patients with therapeutic errors (27.3% of all cases). Dispensing cup errors were implicated in 23 cases; 15 patients assumed the dispensing cup was the unit of measure. No symptoms developed in 63.0%; 27.8% had related symptoms. No related symptoms were life-threatening, and no fatalities occurred. The most frequent symptoms were drowsiness (15.7%), vomiting (4.2%), and abdominal pain or burning (3.7%). The frequency of related symptoms was compared in patients receiving the most frequently utilized decontamination modalities: ipecac alone, activated charcoal alone, lavage and activated charcoal, and ipecac and activated charcoal. Compared to the 112 patients who received no decontamination, only the ipecac-treated group demonstrated a significant reduction in the frequency of related symptoms; 13.9% of patients given ipecac alone (without other gastric decontamination) had related symptoms compared to 33.0% of patients who received no decontamination. Three patients received naloxone for CNS symptoms related to loperamide; two responded and the response of the third was unknown. CONCLUSION: Within the range of doses implicated in this study (up to 0.94 mg/kg), there were no life threatening clinical effects and no fatalities. Development of a management protocol is complicated by the absence of a predictable clinical response in each dose range. The data suggest that children over six months with single acute ingestions up to 0.4 mg/kg, and possibly higher, can be safely managed at home, without gastric decontamination.
Adolescent↗
Poison treatment in the home. American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention.
The ingestion of a potentially poisonous substance by a young child is a common event, with the American Association of Poison Control Centers reporting approximately 1.2 million such events in the United States in 2001. The American Academy of Pediatrics (AAP) has long concerned itself with this issue and has made poison prevention an integral component of its injury prevention initiatives. A key AAP recommendation has been to keep a 1-oz bottle of syrup of ipecac in the home to be used only on the advice of a physician or poison control center. Recently, there has been interest regarding activated charcoal in the home as a poison treatment strategy. After reviewing the evidence, the AAP believes that ipecac should no longer be used routinely as a home treatment strategy, that existing ipecac in the home should be disposed of safely, and that it is premature to recommend the administration of activated charcoal in the home. The first action for a caregiver of a child who may have ingested a toxic substance is to consult with the local poison control center.
Antidotes↗
Drug overdose--reducing the load.
OBJECTIVE: To review available information about various methods for reducing gastrointestinal absorption of a poison or drug. DATA SOURCES: Articles on overdose and accidental poisoning generated by the Australian Medlars Service and concentrating on the period between 1985 and 1990 were surveyed. Earlier studies were included if relevant. STUDY SELECTION AND DATA EXTRACTION: English language articles with an emphasis on studies using objective methods to measure individual and comparative efficacy of gastrointestinal decontamination techniques were selected. A total of 65 articles were reviewed. DATA SYNTHESIS: Gastric emptying procedures (gastric lavage or emesis caused by syrup of ipecac) are only effective if performed within one hour of drug ingestion. Gastric lavage is superior to syrup of ipecac. Oral administration of activated charcoal is more effective than either gastric emptying procedure, and is recommended for most cases of poisoning. Cathartics (sorbitol) can be used with activated charcoal. Whole bowel lavage with polyethylene glycol is indicated in selected cases of potentially lethal overdose where the toxic substance cannot be absorbed by charcoal and has passed the pylorus. CONCLUSIONS: Children--syrup of ipecac can be given at home to children older than 12 months. Most children who reach hospital can be treated by charcoal alone. ADULTS--Most patients are managed with supportive care and, in the absence of contraindications, a single dose of activated charcoal if seen within four hours of ingestion of the poison or drug. Gastric lavage is used if the patient presents within one hour of ingestion and has clinical features of toxicity.
Adult↗
Psychotrine and its O-methyl ether are selective inhibitors of human immunodeficiency virus-1 reverse transcriptase.
Psychotrine dihydrogen oxalate and O-methylpsychotrine sulfate heptahydrate (MP), the salts of isoquinoline alkaloids from ipecac, were found to be potent inhibitors of the DNA polymerase activity of human immunodeficiency virus-1 reverse transcriptase (HIV-1 RT). We currently report the results of additional studies designed to characterize the mechanism of inhibition facilitated by MP. The inhibition was noncompetitive with respect to TTP and uncompetitive with respect to poly(rA) and oligo(dT)12-18 (4:1) at low template-primer concentrations but competitive at high concentrations (greater than 200 microM). Identical non-Michaelis-type kinetics were observed when activated DNA was used as the template. The biphasic nature of the double-reciprocal plots and Hill coefficients of less than 1 indicate that MP functions as an allosteric inhibitor of the enzyme which appears to possess multiple active sites that interact in a cooperative (negative) fashion in the presence of the inhibitor. MP was selective for the recombinant HIV-1 RT (p66) utilizing poly(rA) and oligo(dT)12-18 (4:1) as template-primer. Greater inhibition was observed with this template primer as compared with other natural and synthetic template-primers tested. MP had significantly less effect on avian myeloblastosis virus RT as well as mammalian or bacterial DNA and RNA polymerases. Other members of the ipecac class of alkaloids, e.g. emetine hydrochloride, were inactive against all of these enzymes, including HIV-1 RT. Conversely, MP did not inhibit in vitro protein synthesis, a property manifested by all the other ipecac alkaloids tested. Studies conducted with structural analogs revealed that the imine functionality at positions 1' and 2' of MP is the key structural requirement for HIV-1 RT inhibitory activity. Therefore, MP appears to possess unique structural properties that enable interaction with HIV-1 RT in a manner that can be differentiated from other polymerases. Use of these alkaloids for the definition of this viral enzyme-specific topology may lead to the development of therapeutically useful chemotherapeutic agents.
Alkaloids↗
A poison prevention program for new mothers.
A program was developed to teach new parents about poison prevention and to introduce syrup of ipecac into their homes. Although the incidence of accidental poisonings is low in newborns, the objective of the program was to educate the parents before the child reaches the age when poison accidents are more likely to occur. To accomplish this a special packet was created which contained poison prevention literature and a redeemable coupon for a free one ounce bottle of syrup of ipecac. The packets were distributed to the new mothers during the postpartum hospital stay by the obstetrical nursing staff. Over 10,000 new mothers received the packets during a 10-month period. This program was funded by a grant from the Hennepin County Community Health Department and the syrup of ipecac was donated by a local retail pharmacy chain.
Female↗
A population pharmacokinetic-pharmacodynamic analysis of repeated measures time-to-event pharmacodynamic responses: the antiemetic effect of ondansetron.
This paper presents and illustrates methodology for specifying, estimating, and evaluating a predictive model for repeated measures time-to-event responses. The illustrative example specifies a model of the antiemetic effect vs. concentration relationship for the 5-HT3 antagonist ondansetron in the human ipecac model for emesis. A key part of this model is a time-dependent log hazard function for emesis that is increased by ipecac administration and decreased by ondansetron concentration. The model is fit using an approximate maximum likelihood method. The data consist of the time free of emeses and, for those individuals with emetic episodes, the time(s) of the episode(s). Model evaluation is accomplished using residual plots adapted to time-to-event data and a "posterior predictive check" wherein observed data statistics are compared to those obtained from data simulated from the fitted model. The ondansetron concentration required to obtain a 50% reduction in the hazard of emesis is estimated to be 1.4 +/- 0.2 ng/ml, and the rate constant for elimination of ipecac-induced hazard is 1.5 +/- 0.2 hr-1.
Antiemetics↗
Unintentional acetaminophen ingestion in children and the potential for hepatotoxicity.
OBJECTIVE: Children who unintentionally ingest acetaminophen are often referred to health care facilities for evaluation. Criteria for referral are not well defined and the vast majority of these exposures result in nontoxic serum concentrations. The objective of this study was to determine the incidence of potentially hepatotoxic serum concentrations and to more clearly define referral criteria for these patients. METHODS: A prospective evaluation of all childhood (age 1-72 months) single ingestions of acetaminophen-containing products was performed by the Utah Poison Control Center. All patients ingesting 140 mg/ kg or greater or an unknown amount were referred for medical evaluation. Patients who ingested greater than 100 mg/kg were advised to administer syrup of ipecac at home if less than 1 hour since ingestion. Activated charcoal was recommended within 2 hours of ingestion if the patient was already at a health care facility. The potential for hepatotoxicity was assessed according to the Rumack-Matthew nomogram. RESULTS: Inclusion criteria were met by 1015 patients. The mean age was 28 +/- 12 months and mean dose was 213 +/- 148 mg/ kg. Decontamination with ipecac, gastric lavage, or activated charcoal within 2 hours of ingestion occurred in 81% of patients ingesting greater than 140 mg/kg or an unknown amount. Six patients (0.59%, 95% CI 0.12-1.16%) had "possible" or "probable" hepatotoxic serum concentrations and all had ingested greater than 200 mg/kg or an unknown amount. There were 423 patients who ingested between 100 and 200 mg/kg and none had potentially hepatotoxic serum concentrations (upper 95% CL 0.71%). CONCLUSIONS: Children who ingest between 140-200 mg/kg of acetaminophen and demonstrate ipecac-induced emesis within 60 minutes may be safely managed at home. Patients ingesting greater than 200 mg/kg or an unknown amount should be referred for a serum acetaminophen concentration.
Acetaminophen↗
The anti-emetic effects of CP-99,994 in the ferret and the dog: role of the NK1 receptor.
1. The selective NK1 receptor antagonist, CP-99,994, produced dose-related (0.1-1.0 mg kg-1, s.c.) inhibition of vomiting and retching in ferrets challenged with central (loperamide and apomorphine), peripheral (CuSO4) and mixed central and peripheral (ipecac, cisplatin) emetic stimuli. 2. Parallel studies with the enantiomer, CP-100,263 (1 mg kg-1, s.c.), which is > 1,000 fold less potent as a NK1 antagonist, indicated that it was without significant effect against CuSO4, loperamide, cisplatin and apomorphine-induced emesis. Against ipecac, it inhibited both retching and vomiting, expressing approximately 1/10th the potency of CP-99,994. 3. The 5-HT3 receptor antagonist, tropisetron (1 mg kg-1, s.c.) inhibited retching and vomiting to cisplatin and ipecac, but not CuSO4 or loperamide. 4. CP-99,994 (1 mg kg-1, i.v.) blocked retching induced by electrical stimulation of the ventral abdominal vagus without affecting the cardiovascular response, the apnoeic response to central vagal stimulation or the guarding and hypertensive response to stimulation of the greater splanchnic nerves. CP-99,994 (1 mg kg-1, i.v.) did not alter baseline cardiovascular and respiratory parameters and it failed to block the characteristic heart rate, blood pressure and respiratory rate/depth changes in response to i.v. 2-methyl-5-HT challenge (von Bezold-Jarisch reflex). 5. Using in vitro autoradiography, [3H]-substance P was shown to bind to several regions of the ferret brainstem with the density of binding in the nucleus tractus solitarius being much greater than in the area postrema. This binding was displaced by CP-99,994 in a concentration-related manner. 6. In dogs, CP-99,994 (40 micrograms kg-1 bolus and 300 micrograms kg-1 h-1, i.v.) produced statistically significant reductions in vomiting to CuSO4 and apomorphine as well as retching to CuSO4. 7. Together, these studies support the hypothesis that the NK1 receptor antagonist properties of CP-99,994 are responsible for its broad spectrum anti-emetic effects. They also suggest that CP-99,994 acts within the brainstem, most probably within the nucleus tractus solitarius although the involvement of the area postrema could not be excluded.
Animals↗
Parental prevention practices for young children in the context of maternal depression.
OBJECTIVE: To assess the relationship between maternal depression and 4 parent-based prevention practices (use of car seats and electrical plug covers, presence of syrup of ipecac in the home, and reading to their child), using a large nationally representative follow-back sample. METHODS: The maternal self-report components of 2 databases were used for this study, the 1988 National Maternal and Infant Health Survey and the linked companion 1991 Longitudinal Follow-Up Survey. A total of 7537 mothers with newborns in 1988 served as the subjects. Measures of the 4 prevention practices were extracted from the 1991 survey. Depressive symptom measures were derived from both surveys using the Center for Epidemiologic Studies-Depression Scale. Weighted bivariate and multivariate logistic analyses were used to assess the relationship between maternal depressive symptoms (trichotomized to depression at both time points, at 1 time point, and at neither time point) and parental prevention practices, while controlling for a wide variety of sociodemographic variables. RESULTS: Mothers reporting a high level of depressive symptoms (Center for Epidemiologic Studies-Depression Scale score >/=16) reported significantly poorer prevention practices for car seat use, covering electrical plugs, and having syrup of ipecac in the home. High depressive symptoms were also related to a lower likelihood of daily reading, but only for those mothers presently living with a male partner. Engagement in all prevention practices, except having syrup of ipecac in the home, were less likely if the mother reported high levels of depressive symptoms at both time points versus a single time point. CONCLUSION: Maternal depression may significantly impede parental prevention practices. As maternal depression is a treatable condition, screening and treating this disorder may contribute to improvement in childhood prevention practices and ultimately child health.
Accident Prevention↗
Emetine myopathy in a patient with an eating disorder.
OBJECTIVE: To alert physicians to the dangers of a readily available, non-prescription drug by describing the clinical and pathological features of myopathy due to chronic poisoning with ipecac syrup in a patient with an eating disorder. CLINICAL FEATURES: A 27-year-old woman presented in 1991 with a right foot drop, followed a few months later by progressive severe neck and limb weakness associated with dysphagia, faecal incontinence and diffuse body ache. It emerged that she had been consuming increasing quantities of ipecac syrup (up to 200 mL per week) for three months to induce vomiting and weight loss. The serum creatine kinase activity was slightly elevated and electromyographic examination results were in keeping with a necrotising proximal myopathic process. Muscle biopsy showed vacuolar degeneration with myofibrilolysis and fine cytoplasmic body formation, consistent with a diagnosis of emetine myopathy. INTERVENTION AND OUTCOME: The patient was advised to stop taking ipecac and observed for the next few months. The symptoms resolved gradually and strength returned to normal in four months. CONCLUSION: Chronic emetine toxicity, with its potentially catastrophic consequences, should be remembered in the evaluation of neuromuscular symptoms in young women, in whom eating disorders are common and often unrecognised.
Adult↗
Poisoning prevention knowledge and practices of parents after a childhood poisoning incident.
This study investigated the effectiveness of a poison center-initiated mailed intervention on improving the preventive practices of families whose preschool child had recently experienced a poisoning incident. A low-cost, mailed poisoning prevention packet consisting of telephone stickers, a +f41 coupon for syrup of ipecac, one slide-style cabinet lock, a nine-step checklist for "poison-proofing" the home, pamphlets, and a cover letter was tested prospectively on a population of parents calling a poison center for advice about possible poisoning exposures involving their preschool children. Parents without ipecac 1 week after the incident were randomized so that half received the mailed intervention. A "blind" follow-up telephone interview was conducted 3 months later. Of the 336 original families enrolled in the study, 301 (90% retention) completed the follow-up interview. Those who had received the intervention were more likely to have a telephone sticker than control families (78% vs 39%; P < .0001) and were more likely to be using at least one slide lock in the home (59% vs 40%; P < .001). However, intervention families were no more likely to have ipecac on hand than control families (57% vs 52%; P = not significant) and did not indicate a higher rate of compliance with suggested changes in other behaviors and practices to prevent poisonings. A poisoning recurrence rate of 3.7% was seen in the total sample during the 3-month period of surveillance; there was no difference between groups in recurrence rate. Even after a poisoning event, parents may not be sufficiently motivated to take poisoning prevention measures on their own.(ABSTRACT TRUNCATED AT 250 WORDS)
Accidents, Home↗