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Syrup of Ipecac

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21. Toxicity, Iron (Treatment)

(10):1-203. . . [Guideline] Höjer J, Troutman WG, Hoppu K, Erdman A, Benson BE, Mégarbane B, et al. Position paper update: ipecac syrup for gastrointestinal decontamination. Clin Toxicol (Phila) . 2013 Mar. 51(3):134-9. . Tenenbein M. Benefits of parenteral deferoxamine for acute iron poisoning. J Toxicol Clin Toxicol . 1996. 34(5):485-9. . Sankar J, Shukla A, Khurana R, Dubey N. Near fatal iron intoxication managed conservatively. BMJ Case Rep . 2013 Jan 31. 2013: . Carlsson M, Cortes D, Jepson S (...) texture and may be difficult to remove by lavage. Whole-bowel irrigation may be used in patients with a radiopacity on kidneys, ureters, bladder (KUB) plain radiographs, until the radiopacity clears. Ipecac has been used for gastric decontamination in patients with iron poisoning. Ipecac might be considered when it can be administered within 60 minutes of iron ingestion, in an alert patient who has ingested a very large amount of iron. Ipecac is not used routinely for iron removal because it can mask

2014 eMedicine.com

22. Toxicity, Cocaine (Treatment)

been ingested (not as part of body packing or body stuffing), the patient without altered mental status may be treated by administration of activated aqueous charcoal. Gastric lavage and induction of vomiting via ipecac syrup are not recommended because of the risk of seizure, with the potential for airway compromise and aspiration of vomitus. Previous Next: Body Packing and Body Stuffing In body packers, although a risk for toxicity exists, the drugs are often carefully packaged to prevent rupture

2014 eMedicine.com

23. Toxicity, Barbiturate (Treatment)

of a few specific antidotes has decreased the mortality rate in unselected overdose patients to less than 1% if the patient arrives at the hospital in time for the clinician to intervene. [ ] Although multiple doses of activated charcoal (MDAC) have been shown to enhance elimination of phenobarbital and to reduce the serum half-life, a definite improvement in clinical outcome has not been shown in any studies using MDAC. Induction of emesis with ipecac syrup is contraindicated in these patients because

2014 eMedicine.com

24. Digitalis Toxicity (Treatment)

in patients with renal insufficiency. Other points to consider include the following: Induced emesis with ipecac syrup is not recommended, because of the increased vagal effect Whole-bowel irrigation may be useful, but clinical data are lacking Forced diuresis is not recommended, because it has not been shown to increase renal excretion and can worsen electrolyte abnormalities Dialysis has been shown to produce only small additional clearance Gastric lavage increases vagal tone and may precipitate

2014 eMedicine.com

25. Toxicity, Iron (Follow-up)

(10):1-203. . . [Guideline] Höjer J, Troutman WG, Hoppu K, Erdman A, Benson BE, Mégarbane B, et al. Position paper update: ipecac syrup for gastrointestinal decontamination. Clin Toxicol (Phila) . 2013 Mar. 51(3):134-9. . Tenenbein M. Benefits of parenteral deferoxamine for acute iron poisoning. J Toxicol Clin Toxicol . 1996. 34(5):485-9. . Sankar J, Shukla A, Khurana R, Dubey N. Near fatal iron intoxication managed conservatively. BMJ Case Rep . 2013 Jan 31. 2013: . Carlsson M, Cortes D, Jepson S (...) texture and may be difficult to remove by lavage. Whole-bowel irrigation may be used in patients with a radiopacity on kidneys, ureters, bladder (KUB) plain radiographs, until the radiopacity clears. Ipecac has been used for gastric decontamination in patients with iron poisoning. Ipecac might be considered when it can be administered within 60 minutes of iron ingestion, in an alert patient who has ingested a very large amount of iron. Ipecac is not used routinely for iron removal because it can mask

2014 eMedicine.com

26. Digitalis Toxicity (Follow-up)

in patients with renal insufficiency. Other points to consider include the following: Induced emesis with ipecac syrup is not recommended, because of the increased vagal effect Whole-bowel irrigation may be useful, but clinical data are lacking Forced diuresis is not recommended, because it has not been shown to increase renal excretion and can worsen electrolyte abnormalities Dialysis has been shown to produce only small additional clearance Gastric lavage increases vagal tone and may precipitate

2014 eMedicine.com

27. Toxicity, Mushrooms - Ibotenic Acid (Treatment)

medications. If patients are severely agitated, anxiolytics (eg, benzodiazepines) may be needed. For seizures lasting longer than 5 minutes, various anticonvulsants have been used. It should be kept in mind that respiratory depression has been reported when these agents are administered IV. Preparations must therefore be made to support the airway if necessary. [ ] Ipecac syrup should generally be avoided. Central nervous system (CNS) symptoms develop relatively rapidly after ingestion of ibotenic acid (...) −containing mushrooms, and evidence for the effectiveness of ipecac in this setting is lacking. With A muscaria poisoning, despite the implications of the species name, few muscarinic effects are observed; consequently, anticholinergic drugs such as atropine are rarely, if ever, needed. Fever in this setting should not be treated with antipyretics; it is probably the result of agitation and increased motor activity. Previous Next: Prevention Cautious mushroom hunters eat only 1 type of mushroom and save

2014 eMedicine Pediatrics

28. Toxicity, Mushrooms - Muscarine (Treatment)

medications. If patients exhibit excessive bronchial secretions or other symptoms of cholinergic excess (bradycardia) that are of significant concern, atropine may decrease these symptoms. If the patient presents within 1 hour of ingestion, oral administration of activated charcoal may be considered, [ ] but adsorption to activated charcoal has not been demonstrated for these constituents. [ ] No evidence suggests that routine administration of multiple doses of activated charcoal is useful. Ipecac syrup

2014 eMedicine Pediatrics

29. Toxicity, Hydrocarbons (Treatment)

hydrocarbons (PAHs) as individual compounds and in complex mixtures. Environ Sci Technol . 2013 Aug 29. . [Guideline] Höjer J, Troutman WG, Hoppu K, Erdman A, Benson BE, Mégarbane B, et al. Position paper update: ipecac syrup for gastrointestinal decontamination. Clin Toxicol (Phila) . 2013 Mar. 51 (3):134-9. . Balme KH, Zar H, Swift DK, Mann MD. The efficacy of prophylactic antibiotics in the management of children with kerosene-associated pneumonitis: a double-blind randomised controlled trial. Clin (...) inhalation and cutaneous absorption may occur long after the exposure. Health care providers must take precautionary action to minimize their own exposure to the toxic substance. Gastric decontamination in cases of oral ingestion is controversial. Ipecac-induced emesis is contraindicated in patients who have ingested a low-viscosity hydrocarbon (eg, gasoline, kerosene, furniture polish, mineral spirits) because the aspiration risk is high. [ ] Before gastric decontamination is performed, the airway must

2014 eMedicine Pediatrics

30. Toxicity, Iron (Treatment)

of the American Association of Poison Control Centers' National Poison Data System (NPDS): 35th Annual Report. Clin Toxicol (Phila) . 2018 Dec 21. 51(10):1-203. . . Siff JE, Meldon SW, Tomassoni AJ. Usefulness of the total iron binding capacity in the evaluation and treatment of acute iron overdose. Ann Emerg Med . 1999 Jan. 33(1):73-6. . [Guideline] Höjer J, Troutman WG, Hoppu K, Erdman A, Benson BE, Mégarbane B, et al. Position paper update: ipecac syrup for gastrointestinal decontamination. Clin Toxicol (...) by the GI tract. Ipecac-induced emesis is not recommended. This is especially true in iron ingestion, as GI distress is an early finding in iron poisoning and is present in all potentially serious ingestions, and ipecac-induced vomiting may cloud the clinical picture. In any event, ipecac is rapidly becoming unavailable. [ ] Gastric lavage is not recommended because iron tablets are relatively large and become sticky in gastric fluid, making lavage unlikely to be of benefit. Whole bowel irrigation has

2014 eMedicine Pediatrics

31. Toxicity, Hallucinogens - PCP (Treatment)

. Activated charcoal adsorbs PCP and increases its nonrenal clearance. [ ] Because mental status can abruptly change, ipecac syrup and GI lavage are not recommended for GI decontamination. Because PCP is a weak base, treatment in the past included acidification of the patient's urine to increase the drug's urinary excretion. This therapy is no longer recommended because severely intoxicated patients are at risk for acidosis and rhabdomyolysis and because the acidification of urine promotes

2014 eMedicine Pediatrics

32. Toxicity, Mushrooms - Ibotenic Acid (Follow-up)

medications. If patients are severely agitated, anxiolytics (eg, benzodiazepines) may be needed. For seizures lasting longer than 5 minutes, various anticonvulsants have been used. It should be kept in mind that respiratory depression has been reported when these agents are administered IV. Preparations must therefore be made to support the airway if necessary. [ ] Ipecac syrup should generally be avoided. Central nervous system (CNS) symptoms develop relatively rapidly after ingestion of ibotenic acid (...) −containing mushrooms, and evidence for the effectiveness of ipecac in this setting is lacking. With A muscaria poisoning, despite the implications of the species name, few muscarinic effects are observed; consequently, anticholinergic drugs such as atropine are rarely, if ever, needed. Fever in this setting should not be treated with antipyretics; it is probably the result of agitation and increased motor activity. Previous Next: Prevention Cautious mushroom hunters eat only 1 type of mushroom and save

2014 eMedicine Pediatrics

33. Toxicity, Mushrooms - Muscarine (Follow-up)

medications. If patients exhibit excessive bronchial secretions or other symptoms of cholinergic excess (bradycardia) that are of significant concern, atropine may decrease these symptoms. If the patient presents within 1 hour of ingestion, oral administration of activated charcoal may be considered, [ ] but adsorption to activated charcoal has not been demonstrated for these constituents. [ ] No evidence suggests that routine administration of multiple doses of activated charcoal is useful. Ipecac syrup

2014 eMedicine Pediatrics

34. Toxicity, Hydrocarbons (Follow-up)

Technol . 2013 Aug 29. . [Guideline] Höjer J, Troutman WG, Hoppu K, Erdman A, Benson BE, Mégarbane B, et al. Position paper update: ipecac syrup for gastrointestinal decontamination. Clin Toxicol (Phila) . 2013 Mar. 51 (3):134-9. . Balme KH, Zar H, Swift DK, Mann MD. The efficacy of prophylactic antibiotics in the management of children with kerosene-associated pneumonitis: a double-blind randomised controlled trial. Clin Toxicol (Phila) . 2015 Jun 26. 1-8. . Anas N, Namasonthi V, Ginsburg CM

2014 eMedicine Pediatrics

35. Toxicity, Iron (Follow-up)

of the American Association of Poison Control Centers' National Poison Data System (NPDS): 35th Annual Report. Clin Toxicol (Phila) . 2018 Dec 21. 51(10):1-203. . . Siff JE, Meldon SW, Tomassoni AJ. Usefulness of the total iron binding capacity in the evaluation and treatment of acute iron overdose. Ann Emerg Med . 1999 Jan. 33(1):73-6. . [Guideline] Höjer J, Troutman WG, Hoppu K, Erdman A, Benson BE, Mégarbane B, et al. Position paper update: ipecac syrup for gastrointestinal decontamination. Clin Toxicol (...) by the GI tract. Ipecac-induced emesis is not recommended. This is especially true in iron ingestion, as GI distress is an early finding in iron poisoning and is present in all potentially serious ingestions, and ipecac-induced vomiting may cloud the clinical picture. In any event, ipecac is rapidly becoming unavailable. [ ] Gastric lavage is not recommended because iron tablets are relatively large and become sticky in gastric fluid, making lavage unlikely to be of benefit. Whole bowel irrigation has

2014 eMedicine Pediatrics

36. Toxicity, Cough and Cold Preparation (Follow-up)

experience seizures and aspirate charcoal. Gastric emptying has not proven beneficial if the patient presents more than 1 hour postingestion, although case reports involving anticholinergic agents have demonstrated erratic absorption and repeated worsening of anticholinergic symptoms over 9 days. Ipecac syrup is not recommended in the ED because it may delay the administration of activated charcoal and seizures may occur at any time, with the possibility of aspiration. Repeated doses of activated (...) . Other methods of decontamination Controversial methods of decontamination include gastric lavage and ipecac syrup. Use of these agents should be on the advice of a poison center or toxicologist. Ipecac and gastric lavage have fallen into disfavor, and cathartic therapy is not recommended, especially in children. Emesis is not usually recommended and is specifically contraindicated if a depressed gag reflex, CNS depression, ingestion of a corrosive substance, or situation with high aspiration

2014 eMedicine Pediatrics

37. Toxicity, Digitalis (Follow-up)

in patients with renal insufficiency. Other points to consider include the following: Induced emesis with ipecac syrup is not recommended, because of the increased vagal effect Whole-bowel irrigation may be useful, but clinical data are lacking Forced diuresis is not recommended, because it has not been shown to increase renal excretion and can worsen electrolyte abnormalities Dialysis has been shown to produce only small additional clearance Gastric lavage increases vagal tone and may precipitate

2014 eMedicine Pediatrics

38. Toxicity, Deadly in a Single Dose (Treatment)

. Previous Next: Gastric Decontamination The American Academy of Clinical Toxicology (AACT) and the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) maintain updated position statements on gastric decontamination. Current recommendations cover the following [ ] : Ipecac syrup Single-dose activated charcoal Multi-dose activated charcoal Cathartics Whole-bowel irrigation (WBI) Gastric lavage Activated charcoal The position paper advises that use of single-dose activated charcoal (...) , no controlled studies demonstrate that the enhanced elimination of those drugs provides clinical benefit. Other decontamination methods Recommendations on other methods are as follows [ ] : Ipecac syrup: The routine administration of ipecac at the site of ingestion or in the emergency department should definitely be avoided; in any case, ipecac is rapidly becoming unavailable Cathartics are not recommended as a method of gut decontamination Gastric lavage should not be performed routinely, if at all

2014 eMedicine Pediatrics

39. Toxicity, Cough and Cold Preparation (Treatment)

experience seizures and aspirate charcoal. Gastric emptying has not proven beneficial if the patient presents more than 1 hour postingestion, although case reports involving anticholinergic agents have demonstrated erratic absorption and repeated worsening of anticholinergic symptoms over 9 days. Ipecac syrup is not recommended in the ED because it may delay the administration of activated charcoal and seizures may occur at any time, with the possibility of aspiration. Repeated doses of activated (...) . Other methods of decontamination Controversial methods of decontamination include gastric lavage and ipecac syrup. Use of these agents should be on the advice of a poison center or toxicologist. Ipecac and gastric lavage have fallen into disfavor, and cathartic therapy is not recommended, especially in children. Emesis is not usually recommended and is specifically contraindicated if a depressed gag reflex, CNS depression, ingestion of a corrosive substance, or situation with high aspiration

2014 eMedicine Pediatrics

40. Toxicity, Digitalis (Treatment)

in patients with renal insufficiency. Other points to consider include the following: Induced emesis with ipecac syrup is not recommended, because of the increased vagal effect Whole-bowel irrigation may be useful, but clinical data are lacking Forced diuresis is not recommended, because it has not been shown to increase renal excretion and can worsen electrolyte abnormalities Dialysis has been shown to produce only small additional clearance Gastric lavage increases vagal tone and may precipitate

2014 eMedicine Pediatrics

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