Ipecac-Induced Emesis and Reduction of Plasma Concentrations of Drugs Following Accidental Overdose in Children

Abstract

Syrup of ipecac is widely used following accidental drug overdosage in children. Proof of its efficacy, however, in reducing the risk of poisoning is limited. We prospectively studied the effect of early v late induction of emesis by ipecac in 50 children younger than 5 years of age with accidental acetaminophen poisoning. The mean estimated ingested dose was 165 mg/kg, and all patients vomited within 15 to 255 (mean 78) minutes postingestion. Although the predicted four-hour plasma acetaminophen concentration was 97 ± 4 µg/mL (mean ± SEM, calculated on the basis of the estimated ingested dose), the measured four-hour plasma acetaminophen concentration was 34 ± 5 µg/mL (P < .01). To assess the efficacy of early v late ipecac-induced emesis, we used the ratio of measured to predicted four-hour acetaminophen plasma concentration. The ratio of the measured to predicted four-hour level increased as the delay in time to vomiting increased (r = .60, P < .001). Ipecac syrup was administered more promptly when available in the home than when obtained from a pharmacy or a medical facility (26 ± 8 v 83 ± 13 minutes postingestion, respectively; P < .001) and vomiting occurred earlier (49 ± 9 v 103 ± 12 minutes postingestion; P < .01). Although the mean estimated doses ingested were greater in patients who received ipecac syrup at home, their four-hour plasma acetaminophen concentrations were lower. These data suggest that prompt administration of ipecac syrup results in a greater reduction in plasma acetaminophen concentrations in potentially toxic overdosages in children. Further availability of ipecac syrup at home facilitates its prompt use.