Guideline on the use of ipecac syrup in the out-of-hospital management of ingested poisons

Clinical Toxicology

Volumn 43, Issue 1, 2005, Pages 1-10

  Manoguerra, Anthony S ^a   Cobaugh, Daniel J ^a  

^a American Association of Poison Control Centers   (United States)

Author keywords

Emesis; Ipecac syrup; Poisoning management guideline

Indexed keywords

ACTIVATED CARBON; IPECAC; NON PRESCRIPTION DRUG; AMINOPHYLLINE; AMPICILLIN; ANTIDEPRESSANT AGENT; BARIUM SULFATE; BORIC ACID; CENTRAL STIMULANT AGENT; CHLORPHENIRAMINE; CIMETIDINE; CYANOCOBALAMIN; ISONIAZID; PARACETAMOL; PINDOLOL; SALICYLATE SODIUM; SALICYLIC ACID; SUCRALFATE; TETRACYCLINE; THEOPHYLLINE; THIAMINE; TILIDINE;

BRAIN HEMORRHAGE; CARDIOPULMONARY ARREST; CLINICAL RESEARCH; CONSENSUS DEVELOPMENT; DIAPHORESIS; DIARRHEA; DRUG CONTRAINDICATION; DRUG EFFICACY; DRUG FATALITY; DRUG FEVER; DRUG SAFETY; EMERGENCY TREATMENT; ESOPHAGITIS; FOLLOW UP; GASTROINTESTINAL ABSORPTION; GEOGRAPHY; HEMIPLEGIA; HUMAN; HYPERACTIVITY; INTOXICATION; IRRITABILITY; LETHARGY; NONHUMAN; ORTHOSTATIC HYPOTENSION; PATIENT SELECTION; POISON CENTER; PRACTICE GUIDELINE; REVIEW; SEDATION; STOMACH EMPTYING; STOMACH RUPTURE; TREATMENT OUTCOME; VOMITING; AUTOPSY; CARDIOMYOPATHY; CLINICAL TRIAL; CONSCIOUSNESS DISORDER; CONVALESCENCE; CONVULSION; DRUG OVERDOSE; DRUG SELF ADMINISTRATION; FOOD AND DRUG ADMINISTRATION; GASTROINTESTINAL ENDOSCOPY; HEART ARREST; INFORMATION RETRIEVAL; MEDICAL LITERATURE; MEDICAL SPECIALIST; MENTAL DISEASE; METHODOLOGY; MYOPATHY; OUTPATIENT DEPARTMENT; PNEUMOMEDIASTINUM; PNEUMORETROPERITONEUM; SIDE EFFECT; STOMACH LAVAGE; TREATMENT CONTRAINDICATION; TREATMENT PLANNING;

EMERGENCY TREATMENT; EMETICS; HUMANS; IPECAC; POISON CONTROL CENTERS; POISONING; UNITED STATES; VOMITING;

CEPHAELIS IPECACUANHA; EMESIS;

EID: 13144274709     PISSN: 07313810     EISSN: None     Source Type: Journal    
DOI: 10.1081/CLT-46735     Document Type: Review

References (89)

1. Jukes E. New means of extracting opium etc. from the stomach. Lond Med Phys J 1822; 48:384-389.
2. Bush F. On the common syringe with a flexible tube, as applicable to the removal of opium and other poisons from the stomach. Lond Med Phys J 1822; 48:218-220.
3. White W. Materia Medica, Pharmacy, Pharmacology and Therapeutics. London: J & A Churchill, 1892.
4. Arnold F, Hodges J, Barta R, Spector S, Sunshine I, Wedgwood R. Evaluation of the efficacy of lavage and induced emesis in treatment of salicylate poisoning. Pediatrics 1959; 23:286-301.
5. Boxer L, Anderson FP, Rowe DS. Comparison of ipecac-induced emesis with gastric lavage in the treatment of acute salicylate ingestion. J Pediatr 1969; 74(5):800-803.
6. Robertson WO. Syrup of ipecac. A fast or slow emetic? Am J Dis Child 1962; 103:136-139.
7. Howland MA. Syrup of ipecac. In: Goldfrank LR, Howland MA, Flomenbaum NE, Hoffman RS, Lewin LS, Nelson LS, eds. Goldfrank's Toxicologic Emergencies. 7th ed. New York: McGraw-Hill, 2002:465-468.
8. Litovitz TL, Klein-Schwartz W, Rodgers GC Jr, Cobaugh DJ, Youniss J, Omslaer JC, May ME, Woolf AD, Benson BE. 2001 annual report of the American association of poison control centers toxic exposure surveillance system. Am J Emerg Med 2002; 20(5):391-452.
9. Litovitz TL, Klein-Schwartz W, White S, Cobaugh DJ, Youniss J, Omslaer JC, Drab A, Benson BE. 2000 annual report of the American association of poison control centers toxic exposure surveillance system. Am J Emerg Med 2001; 19(5):337-395.
10. Shaneyfelt TM, Mayo-Smith MF, Rothwangl J. Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA 1999; 281(20):1900-1905.
11. In: Goldfrank LR, Flomenbaum NE, Lewin NA, Weisman RS, Howland MA, Hoffman RS, eds. Goldfrank's Toxicologic Emergencies. 6th ed. Stamford, CT: Appleton & Lange, 1998.
12. In: Haddad LM, Shannon MW, Winchester JF, eds. Clinical Management of Poisoning and Drug Overdose. 3rd ed. Philadelphia: W.B. Saunders, 1998.
13. In: Ellenhorn MJ, ed. Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. 2nd ed. Baltimore: Williams & Wilkins, 1997.
14. Ford MD, Delaney KA, Ling LJ, Erickson T. Clinical Toxicology. Philadelphia: W.B. Saunders, 2000.
15. In: Olson KR, ed. Poisoning & Drug Overdose. 3rd ed. Stamford, CT: Appleton & Lange, 1999.
16. In: Viccellio P, ed. Emergency Toxicology. 2nd ed. Philadelphia: Lippincott-Raven, 1998.
17. Toll LL, Hurlbut KM. Poisindex System. Thomson Micromedex, Greenwood Village, CO. (Edition Expired August 2002).
18. Krenzelok EP, McGuigan M, Lheur P. Position statement: ipecac syrup. American academy of clinical toxicology European association of poisons centres and clinical toxicologists. J Toxicol Clin Toxicol 1997; 35(7):699-709.
19. Woolf SH, Battista RN, Anderson GM, Logan AG, Wang E. Assessing the clinical effectiveness of preventive maneuvers: analytic principles and systematic methods in reviewing evidence and developing clinical practice recommendations. A report by the Canadian task force on the periodic health examination. J Clin Epidemiol 1990; 43(9):891-905.
20. Malcolm SB, Kuzemko JA. Ipecac syrup in acute poisoning in children. Practitioner 1969; 202(211):666-667.
21. MacLean WC Jr. A comparison of ipecac syrup and apomorphine in the immediate treatment of ingestion of poisons. J Pediatr 1973; 82(1):121-124.
22. Veltri JC, Temple AR. Telephone management of poisonings using syrup of ipecac. Clin Toxicol 1976; 9(3):407-417.
23. Schofferman JA. A clinical comparison of syrup of ipecac and apomorphine use in adults. JACEP 1976; 5(1):22-25.
24. Ilett KF, Gibb SM, Unsworth RW. Syrup of ipecacuanha as an emetic in adults. Med J Aust 1977; 2(3):91-93.
25. Krenzelok EP, Dean BS. Syrup of ipecac in children less than one year of age. J Toxicol Clin Toxicol 1985; 23(2-3):171-176.
26. Litovitz TL, Klein-Schwartz W, Oderda GM, Matyunas NJ, Wiley S, Gorman RL. Ipecac administration in children younger than 1 year of age. Pediatrics 1985; 76(5):761-764.
27. Thoman ME, Verhulst HL. Ipecac syrup in antiemetic ingestion. JAMA 1966; 196(5):433-434.
28. Manoguerra AS, Krenzelok EP. Rapid emesis from high-dose ipecac syrup in adults and children intoxicated with antiemetics or other drugs. Am J Hosp Pharm 1978; 35(11):1360-1362.
29. Neuvonen PJ, Vartiainen M, Tokola O. Comparison of activated charcoal and ipecac syrup in prevention of drug absorption. Eur J Clin Pharmacol 1983; 24(4):557-562.
30. Neuvonen PJ, Olkkola KT. Activated charcoal and syrup of ipecac in prevention of cimetidine and pindolol absorption in man after administration of metoclopramide as an antiemetic agent. J Toxicol Clin Toxicol 1984; 22(2):103-114.
31. Auerbach PS, Osterloh J, Braun O, Hu P, Geehr EC, Kizer KW, McKinney H. Efficacy of gastric emptying: gastric lavage versus emesis induced with ipecac. Ann Emerg Med 1986; 15(6):692-698.
32. Young WF Jr, Bivins HG. Evaluation of gastric emptying using radionuclides: gastric lavage versus ipecac-induced emesis. Ann Emerg Med 1993; 22(9):1423-1427.
33. Saincher A, Sitar DS, Tenenbein M. Efficacy of ipecac during the first hour after drug ingestion in human volunteers. J Toxicol Clin Toxicol 1997; 35(6):609-615.
34. Vasquez TE, Evans DG, Ashburn WL. Efficacy of syrup of ipecac-induced emesis for emptying gastric contents. Clin Nucl Med 1988; 13(9):638-639.
35. Krenzelok EP, Dean BS. Effectiveness of 15-Ml versus 30-Ml doses of syrup of ipecac in children. Clin Pharm 1987; 6(9):715-717.
36. Garrison J, Shepherd G, Huddleston WL, Watson WA. Evaluation of the time frame for home ipecac syrup use when not kept in the home. J Toxicol Clin Toxicol 2003; 41(3):217-221.
37. Abdallah AH, Tye A. A comparison of the efficacy of emetic drugs and stomach lavage. Am J Dis Child 1967; 113(5):571-575.
38. Teshima D, Suzuki A, Otsubo K, Higuchi S, Aoyama T, Shimozono Y, Saita M, Noda K. Efficacy of emetic and united state pharmacopoeia ipecac syrup in prevention of drug absorption. Chem. Pharm. Bull. (Tokyo) 1990; 38(8):2242-2245.
39. Tandberg D, Diven BG, McLeod JW. Ipecac-induced emesis versus gastric lavage: a controlled study in normal adults. Am J Emerg Med 1986; 4(3):205-209.
40. Cordonnier J, Van den Heede M, Heyndrickx A, Wennig R. Disposition of tilidine in a fatal poisoning in man. J Anal Toxicol 1987; 11(3):105-109.
41. Tenenbein M, Cohen S, Sitar DS. Efficacy of ipecac-induced emesis, orogastric lavage, and activated charcoal for acute drug overdose. Ann Emerg Med 1987; 16(8):838-841.
42. McNamara RM, Aaron CK, Gemborys M, Davidheiser S. Efficacy of charcoal cathartic versus ipecac in reducing serum acetaminophen in a simulated overdose. Ann Emerg Med 1989; 18(9):934-938.
43. Minton NA, Glucksman E, Henry JA. Prevention of drug absorption in simulated theophylline overdose. Human Exp Toxicol 1995; 14(2):170-174.
44. Corby DG, Decker WJ, Moran MJ, Payne CE. Clinical comparison of pharmacologic emetics in children. Pediatrics 1968; 42(2):361-364.
45. Saetta JP, Quinton DN. Residual gastric content after gastric lavage and ipecacuanha-induced emesis in self-poisoned patients: an endoscopic study. J R Soc Med 1991; 84(1):35-38.
46. Amitai Y, Mitchell AA, McGuigan MA, Lovejoy FH Jr. Ipecac-induced emesis and reduction of plasma concentrations of drugs following accidental overdose in children. Pediatrics 1987; 80(3):364-367.
47. Underhill TJ, Greene MK, Dove AF. A comparison of the efficacy of gastric lavage, ipecacuanha and activated charcoal in the emergency management of paracetamol overdose. Arch Emerg Med 1990; 7(3):148-154.
48. Bond GR, Requa RK, Krenzelok EP, Normann SA, Tendler JD, Morris CL, McCoy DJ, Thompson MW, McCarthy T, Roblez J, Taylor C, Dolan MA, Curry SC. Influence of time until emesis on the efficacy of decontamination using acetaminophen as a marker in a pediatric population. Ann Emerg Med 1993; 22(9):1403-1407.
49. Kulig K, Bar-Or D, Cantrill SV, Rosen P, Rumack BH. Management of acutely poisoned patients without gastric emptying. Ann Emerg Med 1985; 14(6):562-567.
50. Albertson TE, Derlet RW, Foulke GE, Minguillon MC, Tharratt SR. Superiority of activated charcoal alone compared with ipecac and activated charcoal in the treatment of acute toxic ingestions. Ann Emerg Med 1989; 18(1):56-59.
51. Kornberg AE, Dolgin J. Pediatric ingestions: charcoal alone versus ipecac and charcoal. Ann Emerg Med 1991; 20(6):648-651.
52. Bond GR. Home use of syrup of ipecac is associated with a reduction in pediatric emergency department visits. Ann Emerg Med 1995; 25(3):338-343.
53. Manno BR, Manno JE. Toxicology of ipecac: a review. Clin Toxicol 1977; 10(2):221-242.
54. Wax PM, Cobaugh DJ, Lawrence RA. Should home ipecac-induced emesis be routinely recommended in the management of toxic berry ingestions? Vet Hum Toxicol 1999; 41(6):394-397.
55. Czajka PA, Russell SL. Nonemetic effects of ipecac syrup. Pediatrics 1985; 75(6):1101-1104.
56. Chafee-Bahamon C, Lacouture PG, Lovejoy FH Jr. Risk assessment of ipecac in the home. Pediatrics 1985; 75(6):1105-1109. 1.
57. Wrenn K, Rodewald L, Dockstader L. Potential misuse of ipecac. Ann Emerg Med 1993; 22(9):1408-1412.
58. Tandberg D, Liechty EJ, Fishbein D. Mallory-weiss syndrome: an unusual complication of ipecac-induced emesis. Ann Emerg Med 1981; 10(10):521-523.
59. Wolowodiuk OJ, McMicken DB, O'Brien P. Pneumomediastinum and retropneumoperitoneum: an unusual complication of syrup-of-ipecac-induced emesis. Ann Emerg Med 1984; 13(12):1148-1151.
60. Knight KM, Doucet HJ. Gastric rupture and death caused by ipecac syrup. South Med J 1987; 80(6):786-787.
61. Robertson WO. Syrup of ipecac associated fatality: a case report. Vet Hum Toxicol 1979; 21(2):87-89.
62. Klein-Schwartz W, Gorman RL, Oderda GM, Wedin GP, Saggar D. Ipecac use in the elderly: the unanswered question. Ann Emerg Med 1984; 13(12):1152-1154.
63. Adler AG, Walinsky P, Krall RA, Cho SY. Death resulting from ipecac syrup poisoning. JAMA 1980; 243(19):1927-1928.
64. Robertson WO. Safety of ipecac syrup. JAMA 1980; 244(15):1675.
65. Brotman MC, Forbath N, Garfinkel PE, Humphrey JG. Myopathy due to ipecac syrup poisoning in a patient with anorexia nervosa. Can Med Assoc J 1981; 125(5):453-454.
66. Mateer JE, Farrell BJ, Chou SS, Gutmann L. Reversible ipecac myopathy. Arch Neurol 1985; 42(2):188-190.
67. Bennett HS, Spiro AJ, Pollack MA, Zucker P. Ipecac-induced myopathy simulating dermatomyositis. Neurology 1982; 32(1):91-94.
68. Friedman EJ. Death from ipecac intoxication in a patient with anorexia nervosa. Am J Psychiatr 1984; 141(5):702-703.
69. Moldawsky RJ. Myopathy and ipecac abuse in a bulimic patient. Psychosomatics 1985; 26(5):448-449.
70. Palmer EP, Guay AT. Reversible myopathy secondary to abuse of ipecac in patients with major eating disorders. N Engl J Med 1985; 313(23):1457-1459.
71. Dawson JA, Yager J. A case of abuse of syrup of ipecac resulting in death. J Am Coll Health 1986; 34(6):280-282.
72. Rosenberg NL, Ringel SP. Myopathy from surreptitious ipecac ingestion. West J Med 1986; 145(3):386-388.
73. Schiff RJ, Wurzel CL, Brunson SC, Kasloff I, Nussbaum MP, Frank SD. Death due to chronic syrup of ipecac use in a patient with bulimia. Pediatrics 1986; 78(3):412-416.
74. Friedman AG, Seime RJ, Roberts T, Fremouw WJ. Ipecac abuse: a serious complication in bulimia. Gen Hosp Psych 1987; 9(3):225-228.
75. Halbig L, Gutmann L, Goebel HH, Brick JF, Schochet S. Ultrastructural pathology in emetine-induced myopathy. Acta Neuropathol (Berl) 1988; 75(6):577-582.
76. Kuntzer T, Bogousslavsky J, Deruaz JP, Janzer R, Regli F. Reversible emetine-induced myopathy with ecg abnormalities: a toxic myopathy. J Neurol 1989; 236(4):246-248.
77. Dresser LP, Massey EW, Johnson EE, Bossen E. Ipecac myopathy and cardiomyopathy. J Neurol Neurosurg Psychiatry 1993; 56(5):560-562.
78. Thyagarajan D, Day BJ, Wodak J, Gilligan B, Dennett X. Emetine myopathy in a patient with an eating disorder. Med J Aust 1993; 159(11-12):757-760.
79. Ho PC, Dweik R, Cohen MC. Rapidly reversible cardiomyopathy associated with chronic ipecac ingestion. Clin Cardiol 1998; 21(10):780-783.
80. Cooper C, Kilham H, Ryan M. Ipecac-a substance of abuse. Med J Aust 1998; 168(2):94-95.
81. McClung HJ, Murray R, Braden NJ, Fyda J, Myers RP, Gutches L. Intentional ipecac poisoning in children. Am J Dis Child 1988; 142(6):637-639.
82. Berkner P, Kastner T, Skolnick L. Chronic ipecac poisoning in infancy: a case report. Pediatrics 1988; 82(3):384-386.
83. Sutphen JL, Saulsbury FT. Intentional ipecac poisoning: munchausen syndrome by proxy. Pediatrics 1988; 82(3 Pt 2):453-456.
84. Colletti RB, Wasserman RC. Recurrent infantile vomiting due to intentional ipecac poisoning. J Pediatr Gastroenterol Nutr 1989; 8(3):394-396.
85. Day L, Kelly C, Reed G, Andersen JM, Keljo JM. Fatal cardiomyopathy: suspected child abuse by chronic ipecac administration. Vet Hum Toxicol 1989; 31(3):255-257.
86. Santangelo WC, Richey JE, Rivera L, Fordtran JS. Surreptitious ipecac administration simulating intestinal pseudo-obstruction. Ann Intern Med 1989; 110(12):1031-1032.
87. Johnson JE, Carpenter BL, Benton J, Cross R, Eaton LA Jr, Rhoads JM. Hemorrhagic colitis and pseudomelanosis coli in ipecac ingestion by proxy. J Pediatr Gastroenterol Nutr 1991; 12(4): 501-506.
88. Goebel J, Gremse DA, Artman M. Cardiomyopathy from ipecac administration in munchausen syndrome by proxy. Pediatrics 1993; 92(4):601-603.
89. Schneider DJ, Perez A, Knilamus TE, Daniels SR, Bove KE, Bonnell H. Clinical and pathologic aspects of cardiomyopathy from ipecac administration in munchausen's syndrome by proxy. Pediatrics 1996; 97(6 Pt 1):902-906.