Ipecac at home--a health hazard?

Gastrointestinal decontamination of the poisoned patient

Gastrointestinal decontamination has been a historically accepted modality in the emergency management of oral intoxicants. Theoretically, gastric and whole-bowel emptying procedures hinder absorption, remove toxic substances, prevent clinical deterioration, and hasten recovery. This article presents a current overview of gastrointestinal decontamination. It challenges the accepted precepts of gut decontamination and assesses the utility of syrup of ipecac-induced emesis, orogastric lavage, single-dose-activated charcoal, cathartics, and whole-bowel irrigation.

Is syrup of ipecac still for sale? Comparison of pharmacies in a large urban area--2003 versus 2005

There has been considerable publicity about the lack of benefit and potential dangers of syrup of ipecac. In November 2003, the American Academy of Pediatrics recommended against its use. Pharmacies in Houston, Texas were surveyed by telephone before (survey 1) and after (survey 2) the American Academy of Pediatrics' recommendation to determine whether ipecac availability changed. There were 126 pharmacies interviewed at survey 1, and 128 interviewed at survey 2. Pharmacies in survey 1 were more likely than those in survey 2 to sell ipecac (79% versus 64%, P < .01) and to have it in stock (75% versus 48%, P < .001). Pharmacies mostly stored ipecac on the shelves (67%, survey 1; 59%, survey 2, P = .27). Although syrup of ipecac availability has declined significantly, it is still available in more than 50% of pharmacies. Health care providers should advise against its use and advocate that pharmacies remove it.

Diagnosis and management of the poisoned child

Pediatric toxic ingestions are treated commonly by pediatricians and emergency physicians. Significant injury after these ingestions is infrequent, but identifying the dangerous ingestion is sometimes a difficult task. By performing a detailed history, focused physical examination, and directed laboratory evaluation, an estimation of risk can be developed. This article introduced the term "toxic triage" to describe this process. The toxic triage estimation allows the clinician to make thoughtful decontamination and treatment decisions. Familiarity with the literature supporting or refuting each decontamination method allows educated decisions to be made. Supportive care is an integral part of treatment for all poisonings, from asymptomatic to life-threatening. Most antidotes are used rarely in clinical practice, but familiarity with common antidotes benefits those patients with specific hazardous ingestions. Prevention efforts have the potential to decrease the incidence of pediatric poisonings. The universal poison control center number provided should be distributed and posted in homes, clinics, and emergency departments.

Poison treatment in the home. American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention

The ingestion of a potentially poisonous substance by a young child is a common event, with the American Association of Poison Control Centers reporting approximately 1.2 million such events in the United States in 2001. The American Academy of Pediatrics (AAP) has long concerned itself with this issue and has made poison prevention an integral component of its injury prevention initiatives. A key AAP recommendation has been to keep a 1-oz bottle of syrup of ipecac in the home to be used only on the advice of a physician or poison control center. Recently, there has been interest regarding activated charcoal in the home as a poison treatment strategy. After reviewing the evidence, the AAP believes that ipecac should no longer be used routinely as a home treatment strategy, that existing ipecac in the home should be disposed of safely, and that it is premature to recommend the administration of activated charcoal in the home. The first action for a caregiver of a child who may have ingested a toxic substance is to consult with the local poison control center.

Gastrointestinal decontamination for acute poisoning

Gastric decontamination remains an important element in the therapy of pediatric poisoning; however, several issues remain unresolved. Additional studies, particularly in the clinical setting, are necessary to establish optimal therapeutic recommendations. Based on the data presented in this review, the following general recommendations can be made for gastric decontamination in children: If it is necessary to remove an ingested toxin, ipecac syrup is the preferred method if contraindications to its use are not present. The dose should be 30 ml in children older than 1 year of age and 10 ml in children 6 to 12 months of age. Pending further studies, the use of emetics in children younger than 6 months of age cannot be generally recommended, particularly in the home setting. Gastric lavage should be considered to be of very limited use in pediatric patients. Lavage using small nasogastric tubes, except under special circumstances, is nonproductive and cannot be advocated. If it must be used, a large-bore orogastric hose should be used. Administration of activated charcoal prior to lavage should be considered. In situations in which prompt induction of emesis is not possible or contraindications to emesis exist, activated charcoal followed by, or mixed with, a cathartic (preferably sorbitol) should be used as an alternative to removal of gastric contents. Patients with significant symptoms from ingestion requiring hospitalization should receive repeat doses of charcoal and cathartic until symptoms resolve. Activated charcoal should be given in conjunction with other appropriate therapies. Although the data to substantiate this recommendation are limited, particularly in pediatric patients, it is a benign therapy that holds promise of increasing drug elimination.

The effectiveness of health education on home use of ipecac

It is widely recommended by pediatricians that syrup of ipecac for secondary prevention of poisoning be kept in homes where there are young children. To evaluate the efficacy of this recommendation we measured mother's gain in knowledge of how to use ipecac safely at home. The study population (n = 78) were primarily middle class mothers bringing their 9-month-old infants to one pediatrician at a health maintenance organization for a well-baby visit. The pediatrician delivered health education on poisonings. A before-after study design was used. The highly significant (p less than 0.001) gain in knowledge demonstrates that parents can learn to use ipecac safely at home. The practitioner should limit safety counseling to selected areas most problematic at each age level, and within each topic, should concentrate on the most salient points.