Ipecac toxicity
Revisión del 23:14 4 ene 2026 de Ostermayer (discusión | contribs.) (Prepared the page for translation)
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