Ipecac toxicity: Difference between revisions
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*Occasionally seen used in Munchausen by proxy | *Occasionally seen used in Munchausen by proxy | ||
==Mechanism of Action== | ===Mechanism of Action=== | ||
*Vomiting | *[[Vomiting]] | ||
**Immediate: direct irritation of gastric mucosa | **Immediate: direct irritation of gastric mucosa | ||
**Delayed: absorption, stimulation of chemoreceptor trigger zone | **Delayed: absorption, stimulation of chemoreceptor trigger zone | ||
*Inhibition of protein synthesis in skeletal muscle | *Inhibition of protein synthesis in skeletal muscle | ||
==Toxic Dose== | ===Toxic Dose=== | ||
*Acute | *Acute | ||
**As little as 10 mL of the potent fluid extract can cause death | **As little as 10 mL of the potent fluid extract can cause death | ||
| Line 20: | Line 20: | ||
==Clinical Features== | ==Clinical Features== | ||
===Acute=== | |||
* | *[[Nausea/vomiting]] | ||
*Chronic | *[[Gastritis]] | ||
** | ===Chronic=== | ||
*[[Dehydration]] | |||
*[[Diarrhea]] | |||
*[[Hypokalemia]] | |||
*[[Cardiomyopathy]] | |||
*Myopathy ([[weakness]], hyporeflexia) | |||
==Differential Diagnosis== | |||
{{Nausea and vomiting DDX}} | |||
==Evaluation== | ==Evaluation== | ||
*Emetine can be detected in urine for several weeks | *Emetine can be detected in urine for several weeks | ||
*Electrolytes | *Electrolytes, CPK, LDH | ||
*[[ECG]] | |||
==Management== | ==Management== | ||
* | *No specific antidote exists | ||
*IV fluids | *Supportive care is mainstay of treatment | ||
* | **[[IV fluids]] | ||
**[[Electrolyte repletion]] | |||
==Disposition== | |||
==See Also== | |||
==External Links== | |||
==References== | ==References== | ||
<references/> | |||
[[Category:Toxicology]] | |||
[[Category:GI]] | |||
Latest revision as of 21:46, 29 September 2019
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
- Dehydration
- Diarrhea
- Hypokalemia
- Cardiomyopathy
- Myopathy (weakness, hyporeflexia)
Differential Diagnosis
Nausea and vomiting
Critical
Emergent
- Acute radiation syndrome
- Acute gastric dilation
- Adrenal insufficiency
- Appendicitis
- Bowel obstruction/ileus
- Carbon monoxide poisoning
- Cholecystitis
- CNS tumor
- Electrolyte abnormalities
- Elevated ICP
- Gastric outlet obstruction, gastric volvulus
- Hyperemesis gravidarum
- Medication related
- Pancreatitis
- Peritonitis
- Ruptured viscus
- Testicular torsion/ovarian torsion
Nonemergent
- Acute gastroenteritis
- Biliary colic
- Cannabinoid hyperemesis syndrome
- Chemotherapy
- Cyclic vomiting syndrome
- ETOH
- Gastritis
- Gastroenteritis
- Gastroparesis
- Hepatitis
- Labyrinthitis
- Migraine
- Medication related
- Motion sickness
- Narcotic withdrawal
- Thyroid
- Pregnancy
- Peptic ulcer disease
- Renal colic
- UTI
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