Ipecac toxicity

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

  • No specific antidote exists
  • Supportive care is mainstay of treatment
    • IV fluids
    • Electrolyte repletion

Disposition

See Also

External Links

References