Syrup of ipecac
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Syrup of ipecac (derived from the dried rhizome and roots of the Ipecacuanha plant), is an emetic—a substance used to induce vomiting. It is used in cases of accidental poisoning, and is perhaps the best-known emetic. Ipecac is also used in cough mixtures as an expectorant and from the 18th until the early 20th century, ipecac and opium were used to produce Dover's powder, which was used in syrup form.
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[edit] Mechanism of action
The actions of ipecac are mainly those of its major alkaloids, emetine (methylcephaeline) and cephaeline. They both act locally by irritating the gastric mucosa and centrally by stimulating the medullary chemoreceptor trigger zone to induce vomiting.[1]
[edit] Dosage
In children up to six months of age:
- Ipecac syrup should only be administered under the supervision of a physician
Children 6–12 months of age:
- 5 to 10 mL preceded or followed by 120 to 240 mL of water
Children 1–12 years of age:
- 15 mL preceded or followed by 120–240 mL of water
Adolescents and adults:
- 15 to 30 mL followed immediately by 240 mL of water.
Vomiting typically happens within 15 to 20 minutes. If the patient has not vomited within 20 to 30 minutes, a second dose can be administered.[1] Saving the vomitus is recommended for medical inspection.
[edit] Use
Though it has a long history of use, syrup of ipecac has come under recent scrutiny.[1]
One recent scientific review (2005) by an expert panel concluded that vomiting alone does not reliably remove poisons from the stomach. The study suggested that indications for use of ipecac syrup were rare and patients should be treated by more effective and safer means. Additionally, ipecac’s potential side effects, such as lethargy, can be confused with the poison’s effects, complicating diagnosis. Ipecac may also delay the administration or reduce the effectiveness of other treatments such as activated charcoal, whole bowel irrigation, or oral antidotes.[2]
The current first-line treatment for most ingested poisons is now activated charcoal, which operates much more quickly and effectively than ipecac treatment.[3]
[edit] Abuse
Ipecac has been used by anorexic and bulimic individuals as a means to lose weight. Repeated abuse is believed to cause damage to the heart, which can ultimately result in the user's death.[4] The death of singer Karen Carpenter in 1983 has been popularly attributed to her abuse of ipecac for weight control. Ipecac has also been used by emetophiliacs, people who find vomit sexually arousing.
[edit] Footnotes
- ^ a b c (2004) "Position paper: Ipecac syrup". J Toxicol Clin Toxicol 42 (2): 133-43. PMID 15214617.
- ^ Manoguerra A, Cobaugh D (2005). "Guideline on the use of ipecac syrup in the out-of-hospital management of ingested poisons.". Clin Toxicol (Phila) 43 (1): 1-10. PMID 15732439.
- ^ Bateman D (1999). "Gastric decontamination-a view for the millennium". J Accid Emerg Med 16 (2): 84-6. PMID 10191436.
- ^ Silber T (2005). "Ipecac syrup abuse, morbidity, and mortality: isn't it time to repeal its over-the-counter status?". J Adolesc Health 37 (3): 256-60. PMID 16109351.
