Search PubMed⌕ Search

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.

At least 37 records · Page 2Linked to original sources
PubMed1993

Potential misuse of ipecac.

STUDY OBJECTIVE: To evaluate the use of ipecac by health care professionals. DESIGN: A descriptive case series based on a one-year review of all calls to a poison center. SETTING: A university hospital-affiliated regional poison center. INTERVENTIONS: The use of ipecac was judged appropriate or inappropriate based on the consensus of three professionals associated with the poison center using predetermined contraindications. MEASUREMENTS AND MAIN RESULTS: In 20% of cases in which ipecac was used, its use was inappropriate. The most common inappropriate situation was that too much time had elapsed from the time of ingestion. Among adults the most common contraindication was the ingestion of a substance known to cause altered mental status. Among children, the most common contraindication was the ingestion of a nontoxic substance or amount of substance. The poison center recommended ipecac inappropriately less often than emergency departments and usually in children ingesting a nontoxic substance. EDs recommended ipecac inappropriately with a broader range of contraindications and more often in adults. CONCLUSION: Ipecac has potentially adverse consequences and should not be used reflexively. Providers of emergency care should be educated about possible contraindications to its use.

Adolescent↗
PubMed1995

Home use of syrup of ipecac is associated with a reduction in pediatric emergency department visits.

STUDY OBJECTIVE: To determine whether home use of syrup of ipecac is safe and effective in reducing pediatric emergency department visits. DESIGN: Retrospective, multicenter comparison based on secondary use of a large database. PARTICIPANTS: Children younger than 6 years after acute, accidental ingestion of a pharmaceutical product. INTERVENTIONS: 1990 Data corresponding to the study patients from seven regional poison centers were obtained from the American Association of Poison Control Centers. Poison center management choices (particularly use of syrup of ipecac for home decontamination) and characteristics (distribution of pharmaceutical ingestions managed, work volume per staff, staff experience, and training of decision-making director) were analyzed for their impact on the decision to refer a patient to a health care facility or to manage the patient at home. Statistical techniques included weighted least-squares regression analysis using logistic transformation of dependent variables and the forward selection procedure. Adverse patient outcome was defined as moderate effect, major effect, or death (American Association of Poison Control Centers coding criteria). RESULTS: In all, 55,436 children were included in the analysis (range, 3,839 to 12,691 per poison center). The distribution of medications ingested was similar among centers. Increased home use of syrup of ipecac, decreased frequency of ingestion of "high-risk" drugs, and increased staff experience were associated with decreased referral to a health care facility (P < .0001 for each variable). The forward selection procedure determined that syrup of ipecac use explained 45% of the variation in the poison center referral rates. The percentage of drugs defined as high-risk accounted for an additional 31%, and staff experience accounted for another 10% of the variation. Outcome of patients was excellent. No child died. Two home-managed patients had a major effect, and 26 had a moderate effect. CONCLUSION: Centers that recommended home use of syrup of ipecac more frequently were able to manage childhood poisoning more cost-effectively, without a decrease in safety. Although increased home management was strongly associated with syrup of ipecac use, the reason for this relationship cannot be determined from the data. Management by experienced professionals also contributed to cost-effectiveness.

Child, Preschool↗
PubMed1985

Syrup of ipecac . . . 15 ml versus 30 ml in pediatric poisonings.

A prospective study was conducted to determine whether 30 ml of syrup of ipecac would produce a more rapid emesis than 15 ml in pediatric poisoned victims over twelve months of age. Data from 100 patients, where 15 ml of syrup of ipecac was administered, revealed an average time for emesis to occur of 25.82 minutes. Data from an additional 100 patients in which 30 ml of ipecac syrup was administered shows emesis to occur in 15.76 minutes. Clinically, six patients had repeated episodes of vomiting with 30 ml of ipecac; however, all were completely asymptomatic 60 minutes after ipecac administration. The difference of 10.06 minutes is statistically significant. Another aspect of the study evaluated whether the administration of clear liquids prior to or following ipecac substantially effected the onset of emesis. No differences were noted.

Child, Preschool↗
PubMed1986

Preserving the emetic effect of syrup of ipecac with concurrent activated charcoal administration: a preliminary study.

Activated charcoal is reported to block the emetic effect of syrup of ipecac. Therefore, activated charcoal administration is commonly delayed until syrup of ipecac induced emesis is complete. The advantages of early administration of activated charcoal have been well documented. Preservation of the emetic effect of syrup of ipecac in the presence of activated charcoal may produce a synergistic effect by enhancing toxin elimination. A study was conducted in ten human volunteers to determine if activated charcoal prevents the emetic effect of syrup of ipecac when a temporal separation exists between administration of the two substances. Syrup of ipecac 60 ml plus water 480 ml was administered via an 18 French nasogastric tube followed by an aqueous slurry of activated charcoal 50 g five minutes later. Eight (80%) of the subjects had emesis in a mean time of 20.25 minutes (range 16-26 min). The total dose of activated charcoal was retained for a mean time of 6.75 minutes (range 0-17 min). Two subjects (20%) failed to have emesis. This study illustrates that activated charcoal may not completely block the emetic effect of syrup of ipecac.

Adult↗
PubMed1997

Position statement: ipecac syrup. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists.

In preparing this Position Statement, all relevant scientific literature was identified and reviewed critically by acknowledged experts using agreed criteria. Well-conducted clinical and experimental studies were given precedence over anecdotal case reports and abstracts were not usually considered. A draft Position Statement was then produced and subjected to detailed peer review by an international group of clinical toxicologists chosen by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. The Position Statement went through multiple drafts before being approved by the boards of the two societies and being endorsed by other societies. The Position Statement includes a summary statement for ease of use and is supported by detailed documentation which describes the scientific evidence on which the Statement is based. Syrup of ipecac should not be administered routinely in the management of poisoned patients. In experimental studies the amount of marker removed by ipecac was highly variable and diminished with time. There is no evidence from clinical studies that ipecac improves the outcome of poisoned patients and its routine administration in the emergency department should be abandoned. There are insufficient data to support or exclude ipecac administration soon after poison ingestion. Ipecac may delay the administration or reduce the effectiveness of activated charcoal, oral antidotes, and whole bowel irrigation. Ipecac should not be administered to a patient who has a decreased level or impending loss of consciousness or who has ingested a corrosive substance or hydrocarbon with high aspiration potential.

Acetaminophen↗
PubMed1987

Ipecac-induced emesis and reduction of plasma concentrations of drugs following accidental overdose in children.

Syrup of ipecac is widely used following accidental drug overdosage in children. Proof of its efficacy, however, in reducing the risk of poisoning is limited. We prospectively studied the effect of early v late induction of emesis by ipecac in 50 children younger than 5 years of age with accidental acetaminophen poisoning. The mean estimated ingested dose was 165 mg/kg, and all patients vomited within 15 to 255 (mean 78) minutes postingestion. Although the predicted four-hour plasma acetaminophen concentration was 97 +/- 4 micrograms/mL (mean +/- SEM, calculated on the basis of the estimated ingested dose), the measured four-hour plasma acetaminophen concentration was 34 +/- 5 micrograms/mL (P less than .01). To assess the efficacy of early v late ipecac-induced emesis, we used the ratio of measured to predicted four-hour acetaminophen plasma concentration. The ratio of the measured to predicted four-hour level increased as the delay in time to vomiting increased (r = .60, P less than .001). Ipecac syrup was administered more promptly when available in the home than when obtained from a pharmacy or a medical facility (26 +/- 8 v 83 +/- 13 minutes postingestion, respectively; P less than .001) and vomiting occurred earlier (49 +/- 9 v 103 +/- 12 minutes postingestion; P less than .01). Although the mean estimated doses ingested were greater in patients who received ipecac syrup at home, their four-hour plasma acetaminophen concentrations were lower. These data suggest that prompt administration of ipecac syrup results in a greater reduction in plasma acetaminophen concentrations in potentially toxic overdosages in children.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Home↗
PubMed1988

Syrup of ipecac awareness: the use of a survey to direct future education efforts.

Syrup of ipecac awareness has been a major educational endeavor of our poison center for nearly 15 years. Educational efforts have been widespread and not directed specifically at any demographic population. A telephone survey was developed to determine our effectiveness in creating awareness and to identify demographic trends which would direct our future efforts. Respondents were randomly selected from the metropolitan telephone directory. Four hundred surveys were completed. The data was analyzed for statistical significance using chi square. The demographic background of the respondents compared favorably with that published by the Census Bureau. Fifty and six tenths percent were aware of syrup of ipecac. Age groups between 30-59 were more aware of ipecac than younger or older groups. Females were more aware of ipecac than males (37% vs 2%). There was a direct relationship between the number of years of education and ipecac awareness (college 62%, high school 49%, non-high school 37%). Married and divorced respondents had a higher awareness than single individuals (56% vs 38%). Respondents with working spouses had greater awareness than those with unemployed spouses (65% vs 43%). Twenty-four percent claimed to have ipecac in their home at the time of the survey. This provides significant insight for future direction with our educational efforts.

Adult↗
PubMed1984

Efficacy of ipecac and activated charcoal/cathartic. Prevention of salicylate absorption in a simulated overdose.

Twelve adult volunteers were given 24 81-mg aspirin tablets and were randomly assigned into the following treatment groups: (1) control aspirin, (2) 30 mL of ipecac repeated if vomiting not induced, (3) 60 g of activated charcoal per 15 g of magnesium sulfate (MgSO4), and (4) ipecac repeated if needed, followed by activated charcoal/MgSO4 given 1 1/2 hours after the last vomiting episode. All treatments began 60 minutes following aspirin ingestion. Urine was collected for 48 hours for percent total salicylate excretion. Mean +/- SD recovery of salicylate from urine was as follows: aspirin, 96.3% +/- 7.5%; ipecac 70.3% +/- 11.8%, activated charcoal/MgSO4, 56.4% +/- 12%; and ipecac and activated charcoal/MgSO4, 72.4% +/- 14.1%. Ten subjects completed the study. In group 4, eight of ten subjects vomited the activated charcoal/MgSO4 immediately, making statistical analysis impossible. Analysis revealed that activated charcoal/MgSO4 significantly lowered the absorption of aspirin compared with the control and ipecac-treated groups. Furthermore, ipecac significantly lowered aspirin absorption compared with the control group. We conclude that activated charcoal/MgSO4 used alone is superior to the other treatment modalities at inhibiting the absorption of multiple aspirin tablets.

Adult↗
PubMed1987

Patterns of calling time and ipecac availability among poison center callers.

Over a one-month period all telephone calls from the public (n = 3828) to a regional poison center were analyzed. The proportion of early calls (within ten minutes of exposure) decreased with age. Late calls (greater than 30 minutes) were significantly associated with higher hospital referral rates when compared with earlier calls in children younger than 5 years (4.6% vs 1.8%) and adults (33% vs 15%). Ipecac was available in 59% of the homes of callers with children younger than 5 years. Hospital referrals were significantly less common among children who had ipecac at home (1%) compared with children who did not (3%). While the availability of ipecac was similar among callers and a matched sample of households who previously called the poison center (58%), ipecac was much less frequently available (24%) among households whose members had not previously called the center. These data infer that educating the public to call the poison center promptly may result in reduction of hospital referrals. Poison education efforts should be targeted to populations with low ipecac availability and low utilization of the poison center.

Adolescent↗
PubMed1987

Ipecac abuse: a serious complication in bulimia.

Ipecac abuse among bulimics is being increasingly reported. The case presented is a 19-year-old female with significant eating-related problems, including frequent binges and daily use of ipecac to induce vomiting. Medical evaluation revealed significant muscle weakness, cardiac impairment, and altered levels of serum enzymes. The physical debilitation caused by the ipecac use dissipated following apparent discontinuation of ipecac ingestion. The symptom presentation and management problems in this case are discussed to alert clinicians involved in consultation about ipecac abuse.

Adult↗
PubMed1987

A clinical trial using syrup of ipecac and activated charcoal concurrently.

A prospective study was conducted to determine if the emetic effects of syrup of ipecac are preserved when activated charcoal is administered prior to emesis. Ten overdose patients who fulfilled the entrance criteria for the study were administered 60 mL syrup of ipecac by a nasogastric tube followed immediately by 500 mL of tap water. Ten minutes after the ipecac was administered, an aqueous slurry of 50 g activated charcoal diluted to 500 mL was instilled down the nasogastric tube and the tube was removed. Emetic response and time to emesis were recorded. Thirty minutes after emesis subsided, a second dose of 50 g activated charcoal (with sorbitol) was administered orally. Emetic responses were noted in all ten patients. The patients averaged 3.7 emetic episodes. Emesis commenced in an average of 13.8 minutes from the start of ipecac administration and concluded in an average of 45.9 minutes. These results in patients are similar to those observed in a previously reported volunteer group similarly treated. This protocol allows early administration of activated charcoal while preserving the emetic properties of syrup of ipecac in the patients treated.

Adolescent↗
PubMed1976

A clinical comparison of syrup of ipecac and apomorphine use in adults.

A prospective, randomized study was performed to compare syrup of ipecac to apomorphine as the emetic of choice in poisoning cases. Of the 28 adults studied, 15 patients (54%) received 30 ml of ipecac orally and 13 received 0.1 mg/kg apomorphine subcutaneously. Emesis was successfully induced with initial therapy in 13 of 15 (87%) ipecac-treated patients and 10 of 13 (77%) apomorphine-treated patients. In the ipecac group the mean latency period before onset of vomiting was 11.6 minutes (range 4 to 26 min) and in the apomorphine group, 5.3 minutes (range 2 to 13 min) (P less than .01). In the ipecac group, one patient suffered moderate central nervous system (CNS) depression. No hypotension or respiratory depression was observed in this group. In the apomorphine group significant CNS depression developed in eight patients (62%), hypotension developed in five (38%) and respiratory depression in one. There was no consistent relationship between type of poison ingested and occurrence of side effects.

Adolescent↗
PubMed1997

Efficacy of ipecac during the first hour after drug ingestion in human volunteers.

OBJECTIVE: To determine the decrease of drug absorption when syrup of ipecac is administered at various times within one hour of drug ingestion. METHODS: Ten healthy human volunteers were recruited for a four-limbed randomized crossover study. The three experimental limbs consisted of administration of 30 mL syrup of ipecac, at 5, 30, or 60 minutes after ingestion of 3900 mg acetaminophen as 12 x 325 mg tablets with 250 mL room temperature water. The fourth limb served as control. Blood samples were drawn at 0, 0.5, 1.0, 2.0, 3.0, 4.0, 6.0, and 8.0 hours after analgesic ingestion for serum acetaminophen concentration determination by high-performance liquid chromatography. Repeated measures ANOVA and Tukey's HSD tests were used for group comparisons. RESULTS: The area under the serum concentration vs time curve was (mean +/- SD) 206 +/- 48, 67 +/- 37, 183 +/- 78, and 162 +/- 47 mg/L for control, 5, 30, and 60 minutes, respectively. This corresponds to decreases in bioavailability of 67, 11, and 21%. Only the 5-minute group differed significantly from control (p < 0.05). Sedation was observed as a significant adverse effect of ipecac administration. CONCLUSIONS: Our data do not support benefit from ipecac administration at 30 minutes and beyond. Our data suggest that benefit is lost at some point between 5 and 30 minutes. The sedative effect of ipecac may confound the observation of patients who have ingested sedative hypnotic agents.

Acetaminophen↗
PubMed1999

The availability of activated charcoal and ipecac for home use.

Traditionally, ipecac has been used in the home; however, recently attention has focused on pre-hospital activated charcoal (AC) administration. In an effort to assess the availability of AC and ipecac, we conducted a telephone survey. One-hundred and 18 pharmacies were randomly selected from the 59 counties in California to assess availability of AC (liquid or powder) and/or ipecac. Ninety-four (80%) pharmacies participated. Seventy-nine of the pharmacies had ipecac compared to 8 which had AC. Three pharmacies had pre-mixed aqueous AC while 5 had AC in powder formulation. There was no difference between chains and community in AC or ipecac availability. The major limitations of effective GI decontamination are AC availability and rapidity in its administration. Our results identify a significant delay in the administration of AC if a parent was referred to a local pharmacy for home or pre-hospital decontamination. As more toxicologists and poison centers move towards pre-hospital and home AC much education of pharmacists as well as pediatricians and parents is required.

Charcoal↗
PubMed2002

Urinary excretion of ipecac alkaloids in human volunteers.

Limited data are available regarding urinary excretion of ipecac alkaloids in humans. In this study, ipecac syrup was administered po to 12 healthy human volunteers at a dose of either 20 mL or 30 mL, and urinary excretions of cephaeline and emetine as well as blood and vomit concentrations were detected by HPLC. All participants showed vomiting after the 30 mL dose within 1 h, whereas 2/6 did not show vomiting within 4 h after the 20 mL dose. Percentage recovery of alkaloids in vomit were 39 +/- 38 or 76 +/- 14% after the 20 mL or 30 mL doses, respectively. In most participants, plasma alkaloids reached their maximum levels within I h and became undetectable after 6 h. Total excretions of ipecac alkaloids into the urine within the first 48 h were less than 2%, but both alkaloids were detectable in the urine at 2w in all participants and could be detected up to 12w in 1/2 participants who did not vomit. These results show that ipecac alkaloids may be detectable in urine several weeks after ingestion and suggest that their detection in urine may be helpful to identify the Munchausen syndrome by proxy using ipecac syrup.

Administration, Oral↗
PubMed1986

Syrup of ipecac dosing ... How much is a tablespoonful?

Syrup of ipecac is a safe and effective emetic in pediatric patients. Previous reports demonstrate that syrup of ipecac-induced emesis is dose related. The failure rate and the time for emesis to occur is significantly greater when 15 ml is used compared to 30 ml. To reduce failure rates, efforts such as consuming the entire contents of a 15 ml or 30 ml bottle of syrup of ipecac or using kitchen measuring spoons are frequently employed. Since kitchen measuring spoons and flatware are commonly used to administer 1-2 tablespoons of syrup of ipecac, we measured the delivered dose of 30 standard flatware teaspoons to determine the accuracy of the spoons. The mean dose delivered by a kitchen measuring teaspoon was 5.5 ml (range 3 ml to 6 ml) and 12.7 ml (range 10 ml to 17 ml) for measuring tablespoons. This compares to the serving flatware teaspoon mean delivery volume of 5.8 ml (range 3 ml to 7 ml) and 9.5 ml (range 7 ml to 14 ml) for the flatware tablespoon. There is a significant disparity in the delivery volume of the utensils. We recommend the use of graduated medicine spoons or administration of the contents of an entire 30 ml bottle of syrup of ipecac to ensure optimal effects.

Humans↗
PubMed1986

Death due to chronic syrup of ipecac use in a patient with bulimia.

A 17-year-old girl presented with malaise, weakness, palpitations, dysphagia, myalgias, and weight loss of 1 month's duration. Within 24 hours of admission to the hospital, she had hypotension unresponsive to medical management, intractable congestive heart failure, and arrhythmias; she died. Several empty bottles of syrup of ipecac were later found among her belongings. Syrup of ipecac is commonly used to induce emesis in patients who had ingested toxic substances. The chief pharmacologic property of this agent is due to its alkaloid component, emetine. There have been many previous reports of death due to emetine poisoning in patients receiving ipecac fluid extract and in those treated for amoebic dysentery. However, the literature cites only three case reports of fatalities secondary to chronic ipecac use as a means of losing weight. This is the first report of a death due to chronic ipecac use in an adolescent patient with bulimia. Emetine persists in the body for long periods, and in patients who have ingested it chronically, emetine is extremely toxic, specifically to cardiac smooth and skeletal muscles. With an increased awareness of the importance of weight control in the adolescent age group, the physician must carefully evaluate these patients for the use of emetics.

Adolescent↗
PubMed1986

Expired ipecac syrup efficacy.

A controlled prospective study to evaluate the efficacy of expired ipecac syrup was conducted at two regional poison control centers in New England. During a 6-month period, 200 study patients treated with expired ipecac syrup and 200 control patients treated with unexpired ipecac syrup were evaluated. There were no statistical differences between the control and study groups in patient characteristics (age and sex) and product characteristics (general class, emetic potential, pretreatment, previously opened bottles, and manufacturer). In both control and study groups, emesis occurred in 100% of cases with 90% of patients vomiting with the first dose. The mean time to emesis was 24.7 minutes and 24.8 minutes in the study and control groups, respectively. Expired preparations ranged from 1 month to greater than 4 years postexpiration, with the duration of expiration not altering the mean time to emesis. Mean time to emesis between the two groups was also not affected by manufacturer, pretreatment with milk, or whether the ipecac syrup bottle was previously opened. We conclude that expired ipecac syrup (up to 4 years postexpiration date) is an effective emetic.

Child, Preschool↗