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PubMed1988

Ipecac-induced emesis and gastric lavage are equally unpleasant.

It has been widely held that gastric lavage is more unpleasant than ipecac-induced emesis. In fact, patients are occasionally threatened with large rubber tubes in order to persuade them to drink ipecac. To confirm that this assumption exists, we asked 41 emergency physicians and nurses who had never personally undergone either procedure to estimate the discomfort of each using a 10 cm unsegmented visual analog scale. This "naive" group thought that gastric lavage would be significantly more unpleasant than ipecac-induced emesis (mean scores: lavage = 6.46, emesis = 4.94; P less than .001, paired t-test). Using the same methods, we asked 16 health professionals who had undergone both procedures as part of another study to score the recalled unpleasantness of each procedure. Among these who had actually experienced both, there was no significant difference between the mean scores for lavage (4.09) and emesis (4.62) (P greater than 0.5, paired t-test). The mean score difference (lavage minus emesis) for the "naive" group was significantly greater than for the experimental group (1.52 vs -.53, P less than .001, unpaired t-test). Among normal volunteers, ipecac-induced emesis and gastric lavage are equally unpleasant gastric emptying procedures.

Gastric Lavage↗
PubMed1988

Intentional ipecac poisoning: Munchausen syndrome by proxy.

The intentional poisoning of two children with ipecac by their mothers is described. Intractable vomiting and diarrhea were the initial symptoms in both patients. In addition, one patient had clinical and laboratory evidence of skeletal and cardiac myopathy. Both children were subjected to extensive and invasive diagnostic evaluations before the correct diagnosis of chronic ipecac poisoning was made. These cases illustrate the toxic effects of ipecac ingestion and serve to alert physicians to child abuse by ipecac poisoning.

Child↗
PubMed1985

Reversible ipecac myopathy.

The abuse of ipecac syrup for three years resulted in painless, nonfatigable, chiefly proximal weakness in a 27-year-old woman. Electromyography (EMG) and a muscle biopsy revealed features of a myopathy similar to those previously reported in experimental emetine myopathy. Clinical weakness and EMG abnormalities improved after discontinuation of ipecac administration. A direct toxic action of ipecac (acting through its active alkaloid, emetine hydrochloride) on muscle fibers seemed to be responsible for the weakness in this patient.

Adult↗
PubMed1986

Ipecac-induced emesis versus gastric lavage: a controlled study in normal adults.

Ipecac-induced emesis and gastric lavage are the two procedures most widely used to evacuate the stomachs of patients who have ingested poisons. To resolve a long-standing controversy over the relative efficacy of these two methods, the authors carried out a controlled study in which they administered 25 100-micrograms tablets of cyanocobalamin (vitamin B12) to 18 fasting normal adult volunteers on two separate days. On one day, each subject had emesis induced with 30 ml of ipecac syrup followed by 1,000 ml of tap water; on another day, each underwent gastric aspiration and lavage with a 1.1-cm orogastric tube using 3 l of fluid. Both procedures were begun 10 minutes after the ingestion. The recovered vomitus or gastric washings from each procedure were then analyzed for elemental cobalt using atomic absorption spectrophotometry. The mean rate of recovery of the ingested tracer with ipecac-induced emesis was only 28%, whereas gastric lavage resulted in retrieval of 45% (paired t-test, P less than 0.005). In this study, carefully performed gastric lavage was the more effective method of gastric evacuation of tablets in the adult subject.

Adult↗
PubMed1989

The knee-chest position does not improve the efficacy of ipecac-induced emesis.

Previous studies have shown that ipecac-induced emesis, even if instituted very early, removes only a mean of 28% to 45% of an ingested tracer. Because vomiting is an ancient reflex that occurs in mammals, reptiles, and other animals, we speculated that, in humans, maintaining a sitting rather than a horizontal posture during induced emesis might decrease the efficacy of gastric emptying. To test this hypothesis, 20 normal fasting adult subjects underwent induced emesis in the knee-chest position on one day and in the sitting position on another. Twenty-five 100-micrograms tablets of cyanocobalamin were ingested as a tracer along with 250 mL tap water. Ten minutes after tracer ingestion, 30 mL ipecac syrup and 640 mL tap water were swallowed. All resulting vomitus was homogenized, frozen, and later assayed for cobalt using atomic absorption spectrophotometry. There was no difference in mean tracer recovery with the two positions: knee-chest, 47.2% v sitting, 46.9% (paired t test, P greater than .95). Analysis of cobalt recovery for all 40 episodes of emesis revealed a mean of 51.2 +/- 23.7 (SD) micrograms out of 108.7 micrograms total cobalt ingested (95% Cl, 43.6 to 58.7 micrograms). This represented 47.1% of the administered tracer dose (95% Cl, 40.1% to 54.0%). Even if initiated only ten minutes after an ingestion, ipecac-induced emesis removes an average of less than half of an ingested tracer dose, with a high degree of intersubject variability. Horizontal patient positioning does not appear to improve the efficacy of this procedure.

Adult↗
PubMed1986

Poison exposures and use of ipecac in children less than 1 year old.

Poison exposures in children less than 1 year old and the safety and efficacy of syrup of ipecac in children 9 to 12 months old were evaluated in a prospective eight-month study conducted at the Massachusetts Poison Control Center. Poison exposures in children less than 1 year old represented approximately 9% of the 38,080 calls received. Mobile children (in walkers, crawling, or walking) were at the greatest risk of poisoning. The majority of children (94%) were asymptomatic and none were hospitalized or died. The products involved were primarily plants (38%) and household products (30%). All 21 patients, ages 9 to 12 months, were given 10 mL syrup of ipecac under medical supervision and vomited within one hour. The mean time to vomit was 21.7 (SEM +/- 2.8) minutes. The patients vomited 3.3 (SEM +/- 0.3) times and all episodes of vomiting abated by 26.4 (SEM +/- 6.6) minutes. No significant side effects were noted. The use of the syrup of ipecac in the 9- to 12-month-old child appears to be safe and effective.

Female↗
PubMed1993

Ipecac myopathy and cardiomyopathy.

Two cases of ipecac myopathy, one with associated cardiomyopathy are reported. Both patients were young women with eating disorders who came to medical attention because of diffuse muscle weakness. Clinical and electromyographic data suggested ipecac myopathy and muscle biopsies confirmed this diagnosis. One patient had associated clinical and echocardiographic evidence of significant cardiomyopathy. The myopathy resolved and the echocardiogram returned to normal after discontinuing the use of ipecac.

Adult↗
PubMed1983

The effectiveness of health education on home use of ipecac.

It is widely recommended by pediatricians that syrup of ipecac for secondary prevention of poisoning be kept in homes where there are young children. To evaluate the efficacy of this recommendation we measured mother's gain in knowledge of how to use ipecac safely at home. The study population (n = 78) were primarily middle class mothers bringing their 9-month-old infants to one pediatrician at a health maintenance organization for a well-baby visit. The pediatrician delivered health education on poisonings. A before-after study design was used. The highly significant (p less than 0.001) gain in knowledge demonstrates that parents can learn to use ipecac safely at home. The practitioner should limit safety counseling to selected areas most problematic at each age level, and within each topic, should concentrate on the most salient points.

Accidents, Home↗
PubMed1982

Ipecac-induced myopathy simulating dermatomyositis.

We studied a young woman with an eating disorder. To induce vomiting, she took syrup of ipecac daily for 2 years, and then developed insidious, progressive muscle weakness. Skin findings were similar to those of dermatomyositis. Muscle biopsy, however, was similar to experimental emetine myopathy and lacked inflammatory features. Upon cessation of ipecac abuse, strength returned. We believe that this patient had ipecac-induced muscle weakness.

Adult↗
PubMed2002

Studies for the emetic mechanisms of ipecac syrup (TJN-119) and its active components in ferrets: involvement of 5-hydroxytryptamine receptors.

Ipecac syrup, prepared from a galentical ipecac, contains the nauseant alkaloids cephaeline and emetine. The involvement of receptors and serotonin- and dopamine-metabolizing enzymes in the emesis induced by ipecac syrup and these components was investigated. 1) In ferrets, the selective 5-HT3-receptor antagonist ondansetron (0.5 mg/kg, p.o.) prevented each emesis induced by TJN-119 (0.5 mL/kg, p.o.), cephaeline (0.5 mg/kg, p.o.) and emetine (5.0 mg/kg, p.o.), but the intraperitoneal administration of the selective dopamine D2-receptor antagonist sulpiride failed to significantly suppress the TJN-119, cephaeline and emetine-induced emesis at a dose of 0.1 mg/kg that blocked apomorphine-induced emesis. 2) In the receptor binding assays, cephaeline and emetine had a distinct affinity to 5-HT4 receptor, but no or weak affinity to 5-HT1A, 5-HT3, nicotine, M3, beta1, NK1, and D2 receptors. 3) Cephaeline and emetine did not affect activities of metabolic enzymes of 5-HT and dopamine (MAO-A, MAO-B, tryptophan 5-hydroxylase and tyrosine hydroxylase) in vitro. These results suggest that 5-HT3 receptor plays an important role in the emetic action of TJN-119, cephaeline and emetine, and the 5-HT4 receptor may be involved in their mechanisms.

Animals↗
PubMed1997

Vomiting induction by ipecac syrup in dogs and ferrets.

The dog has been used as an experimental animal in emesis research. In this study, we analyzed the emetic effects of ipecac syrup using a smaller animal, the ferret, and compared its response to that of the dog. Dogs and ferrets were divided into 4 groups (n = 4, each). Each group was given either 0.1, 0.25, 0.5, or 1.0 ml/kg of ipecac syrup, and the latency and numbers of retching and vomiting were recorded. Animals given an equal volume of saline served as controls. The numbers of vomiting and retching increased dose-dependently in both dogs and ferrets, and there was no difference in latency and numbers of vomiting between them. The numbers of retching were greater in ferrets than in dogs at > or = 0.25 ml/kg. Taking these results into consideration, the ferret seems to be as useful as the dog in studies on emetic effects of ipecac syrup.

Animals↗
PubMed1985

Syrup of ipecac in children less than one year of age.

A prospective study was conducted to determine if children less than one year of age developed any complications from syrup of ipecac-induced emesis. All patients in the study were derived from cases received by the poison center. Syrup of ipecac (10 ml) was administered with clear fluids to 24 children less than twelve months of age (mean age 8.7 months; median age 9.0 months; range 3.0-12.0). The average time for the onset of emesis was 26.10 minutes. All children vomited with a single dose of syrup of ipecac. No adverse sequelae such as aspiration or prolonged episodes of emesis were observed. Contrary to the popular belief that emesis may be contraindicated in children less than twelve months of age, we believe that emesis can be safely induced in the home setting in these young children.

Age Factors↗
PubMed1987

The effect of fluid volume on syrup of ipecac emesis time.

Large volumes of fluid have been recommended to aid rapid ipecac-induced emesis, however, large volume intake may also have deleterious effects. We prospectively studied 121 children treated at home by a regional poison center to determine if a relationship existed between fluid volume and time to emesis. These children were treated in the usual manner except that parents were asked to measure the volume of fluid given and to note the time that fluid was given and the time of first emesis. The time ranged from 6 to 58 minutes (mean 20.6) with two who failed to respond and the volume ranged from 0 to 28 ounces (mean 6.7 ounces). In children who respond to ipecac, there is no significant relationship between the amount of fluid given and the time until emesis. We conclude that the traditional recommendation of forcing fluid with syrup of ipecac does not hasten emesis in children.

Beverages↗
PubMed1991

The effect of milk on ipecac-induced emesis.

A prospective study at two regional poison centers was undertaken in 500 children under six years of age (mean age 2.3 y) to resolve the question of whether milk has an effect on ipecac-induced emesis. When home administration of ipecac was recommended, parents were asked to select either milk or clear fluids. The mean volume of fluid +/- standard deviation administered was 159 +/- 72 mL in the milk group and 161 +/- 77 mL in the clear fluid group (p = 0.79). There was no difference in the onset of vomiting (23.4 +/- 18.5 vs. 23.3 +/- 12.9 min, p = 0.92), number of vomiting episodes (3.5 +/- 1.9 vs. 3.4 +/- 1.8, p = 0.65), or duration of vomiting (45 +/- 73 vs. 39 +/- 54 min, p = 0.31) for the milk group compared with the clear fluid group. Side effects including lethargy and diarrhea occurred with similar frequency in both groups. The substance ingested had no effect on onset of vomiting, vomiting duration or number of vomiting episodes. These findings again demonstrate that milk does not interfere with ipecac-induced emesis.

Animals↗
PubMed2000

Pharmacological aspects of ipecac syrup (TJN-119)-induced emesis in ferrets.

In order to elucidate the precise mechanism of ipecac syrup (TJN-119) on the occurrence of vomiting, we examined the effects of ipecac syrup on the abdominal afferent nerve activity as well as on the 5-HT levels of the ileum and area postrema in ferrets. Oral administration of TJN-119 (0.5 mg/kg) produced a significant increase in afferent abdominal vagus nerve activity which lasted approximately 1 hour. The maximum response induced by TJN-119 was estimated to be 219 +/- 18% of the pre-injection level. Cephaeline or emetine, the main alkaloids of ipecac syrup, also demonstrated similar effects on afferent vagus nerve activity. TJN-119 increased the 5-HT content in the ileum but not in the area postrema. These observations illustrate possible mechanisms that may act at peripheral sites. It was recently reported that TJN-119 has a high affinity to 5-HT4 receptors (Hasegawa et al., unpublished data). These results suggest that 5-HT4 receptors may be involved in the emetic action of TJN-119.

Afferent Pathways↗
PubMed1989

Cooperative regional program for distribution of poison prevention information and syrup of ipecac.

A regional program to distribute poison prevention information and syrup of ipecac to families that have regular contact with young children is described. In December 1985 the department of pharmacy services at Bristol Hospital in Connecticut proposed implementation of a poison prevention program targeted to families with young children (less than 12 years of age) in the hospital's five-town service area. A planning committee was created to define program goals and oversee operations. The committee decided that poison prevention kits consisting of an instructional booklet and a one-ounce bottle of syrup of ipecac would be distributed to selected residents of the five-town area, with individual instruction provided in the correct use of syrup of ipecac. Funding was provided principally by the hospital, with some additional money from private foundations. The project was named CAP (Combating Accidental Poisoning) and ran initially from December 1, 1986, to June 30, 1987. Kits were distributed in cooperation with area health-care professionals with whom families had regular contact, including pediatricians, family-practice physicians, and community pharmacies. Apart from the hospital pharmacy service itself, the most effective participants were pediatricians; family-practice physicians were highly ineffective. During the course of the initial CAP program 6610 kits were distributed, with 48.7% going to families considered at high risk for the occurrence of an accidental child poisoning. An ongoing program to distribute these kits to all newly delivered mothers and to all area pediatricians free of charge has resulted in more than 15,000 kits being distributed.(ABSTRACT TRUNCATED AT 250 WORDS)

Connecticut↗
PubMedDate not supplied

Low-volume whole bowel irrigation and salicylate absorption: a comparison with ipecac-charcoal.

STUDY OBJECTIVE: To evaluate two methods of gastrointestinal decontamination, low-volume whole bowel irrigation (WBI) and activated charcoal, for their ability to prevent absorption of salicylate. DESIGN: Randomized, two-phase crossover study. SETTING: A clinical research unit in a university-based teaching hospital. PATIENTS: Six healthy, volunteer men. INTERVENTIONS: Subjects were assigned to receive 3000 ml WBI or syrup of ipecac 30 ml followed by activated charcoal 50 g in sorbitol, and were crossed over to the other treatment phase after 1 week. All treatments began 30 minutes after ingestion of 3.25 g aspirin. Urine was collected over 24 hours for analysis of total urinary excretion of salicylate. Serial blood samples were collected for salicylate determination and were subjected to pharmacokinetic analysis. MEASUREMENTS AND MAIN RESULTS: Mean +/- SD recovery of salicylate were WBI 48.6 +/- 5.4% and ipecac-charcoal 37.0 +/- 2.6% from urine (p < 0.01). CONCLUSION: Ipecac-charcoal produced a significantly lower salicylate absorption (peak concentration, AUC) than WBI (p < 0.01) and thus was superior to low-volume WBI.

Adult↗
PubMed1978

In vitro evidence for ipecac inactivation by activated charcoal.

The in vitro adsorption of the alkaloid emetine, a primary constituent of ipecac, on activated charcoal was studied. The results support the supposition that syrup of ipecac should not be given to counteract poisonings if activated charcoal is also to be administered.

Adsorption↗