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
  • Nausea, vomiting, gastritis, Mallory-Weiss tears, and gastric rupture (rare)
• Chronic
  • Dehydration, hypokalemia, diarrhea, cardiomyopathy, myopathy (weakness, hyporeflexia)

Evaluation

• Emetine can be detected in urine for several weeks
• Electrolytes, BUN/Cr, CPK, LDH, ECG

Management

• Administer activated charcoal
• IV fluids as needed
• Potassium repletion as needed
• Diuretics/pressors for cardiomyopathy and CHF
• No specific antidote

References

• Olson, K. Poisoning and Drug Overdose Clinical Manual. 2004