Diferencia entre revisiones de «Ipecac toxicity»
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==Background== | ==Background== | ||
*Rapidly acting emetic agent | *Rapidly acting emetic agent | ||
*Derived from the ipecacuanha plant | *Derived from the ipecacuanha plant | ||
*Often abused by adults with eating disorders | *Often abused by adults with eating disorders | ||
*Occasionally seen used in Munchausen by proxy | *Occasionally seen used in Munchausen by proxy | ||
===Mechanism of Action=== | ===Mechanism of Action=== | ||
*[[Vomiting]] | |||
*[[Special:MyLanguage/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 | ||
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**Slow elimination of emetine causes cumulative toxicity | **Slow elimination of emetine causes cumulative toxicity | ||
**Daily ingestion of 90-120 mL of syrup for several months 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== | ||
===Acute=== | ===Acute=== | ||
*[[Nausea/vomiting]] | |||
*[[Gastritis]] | *[[Special:MyLanguage/Nausea/vomiting|Nausea/vomiting]] | ||
*[[Special:MyLanguage/Gastritis|Gastritis]] | |||
===Chronic=== | ===Chronic=== | ||
*[[Dehydration]] | |||
*[[Diarrhea]] | *[[Special:MyLanguage/Dehydration|Dehydration]] | ||
*[[Hypokalemia]] | *[[Special:MyLanguage/Diarrhea|Diarrhea]] | ||
*[[Cardiomyopathy]] | *[[Special:MyLanguage/Hypokalemia|Hypokalemia]] | ||
*Myopathy ([[weakness]], hyporeflexia) | *[[Special:MyLanguage/Cardiomyopathy|Cardiomyopathy]] | ||
*Myopathy ([[Special:MyLanguage/weakness|weakness]], hyporeflexia) | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{Nausea and vomiting DDX}} | {{Nausea and vomiting DDX}} | ||
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==Evaluation== | ==Evaluation== | ||
*Emetine can be detected in urine for several weeks | *Emetine can be detected in urine for several weeks | ||
*Electrolytes, CPK, LDH | *Electrolytes, CPK, LDH | ||
*[[ECG]] | *[[Special:MyLanguage/ECG|ECG]] | ||
==Management== | ==Management== | ||
*No specific antidote exists | *No specific antidote exists | ||
*Supportive care is mainstay of treatment | *Supportive care is mainstay of treatment | ||
**[[IV fluids]] | **[[Special:MyLanguage/IV fluids|IV fluids]] | ||
**[[Electrolyte repletion]] | **[[Special:MyLanguage/Electrolyte repletion|Electrolyte repletion]] | ||
==Disposition== | ==Disposition== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Toxicology]] | [[Category:Toxicology]] | ||
[[Category:GI]] | [[Category:GI]] | ||
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Revisión actual - 23:14 4 ene 2026
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