Diferencia entre revisiones de «Ipecac toxicity»
(Created page with "==Background== *Rapidly acting emetic agent *Derived from the ipecacuanha plant *Often abused by adults with eating disorders *Occasionally seen used in Munchausen by proxy =...") |
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| Línea 17: | Línea 17: | ||
*Chronic | *Chronic | ||
**Slow elimination of emetine causes cumulative toxicity | **Slow elimination of emetine causes cumulative toxicity | ||
**Daily ingestion of 90-120 mL of syrup can cause cardiomyopathy and death | **Daily ingestion of 90-120 mL of syrup for several months can cause cardiomyopathy and death | ||
==Clinical Features== | ==Clinical Features== | ||
Revisión del 05:46 9 dic 2016
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