Syrup of Ipecac

1. Mechanism
   1. Induces Vomiting
2. Indications: Gastric Decontamination in poison ingestion
   1. Home management only (No role in the Emergency Department or Clinic)
      1. Not recommended for routine use
      2. Long anticipated delay to medical care might prompt usage (e.g. rural setting)
      3. Only use if directed by Poison control
   2. Not recommended for routine use in poison ingestion
      1. Does not improve outcome or reduce ER referral
      2. Bond (2003) Pediatrics 112:1061-4
   3. If administered, use within 60 minutes of ingestion
3. Advantages
   1. Very effective in Aspirin or Iron ingestion
4. Contraindications
   1. Anticipation of advanced life support in next hour
   2. Children under age 6 months
   3. Decreased Level of Consciousness
      1. Coma
      2. Seizures
   4. Ingestions with serious aspiration risk
      1. Corrosives (acids or bases)
      2. Hydrocarbons (Petroleum products)
   5. Sharp object ingestion
   6. Third trimester of pregnancy
   7. Protracted Emesis
5. Complications
   1. Protracted Emesis
   2. Ineffective if over 1 hour post-ingestion
   3. Delays the administration of charcoal
6. Dose
   1. Background
      1. Follow or precede with 120 to 240 ml water
      2. Do not use in age under 6 months
      3. May repeat dose if no Emesis in 30 minutes
   2. Dose
      1. Adults: 15 to 30 ml Ipecac
      2. Child (<12 years): 15 ml Ipecac
      3. Infant (6-12 months): 5-10 ml Ipecac
7. References
   1. (2004) J Toxicol Clin Toxicol 42(2): 133-43