Influence of time until emesis on the efficacy of decontamination using acetaminophen as a marker in a pediatric population

Bond, G. Randall; Requa, RK; Krenzelok, Edward P.; Normann, Sven A.; Tendler, J. D.; Morris, CL; McCoy, Damon; Thompson, Michael; McCarthy, Timothy J.; Roblez, J; Taylor, Craig D.; Dolan, MA; Curry, Steven C.

doi:10.1016/s0196-0644(05)81986-9

Cited by 41 publications

(5 citation statements)

References 26 publications

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“…In a study in children with nontoxic acetaminophen (paracetamol) concentrations, the mean plasma acetaminophen concentrations were reduced from 33.1 mg/L to 15.7 mg/L (a 52.6% reduction) when emesis was induced up to 59 minutes after ingestion (16). In a study in children with nontoxic acetaminophen (paracetamol) concentrations, the mean plasma acetaminophen concentrations were reduced from 33.1 mg/L to 15.7 mg/L (a 52.6% reduction) when emesis was induced up to 59 minutes after ingestion (16).…”

Section: Clinical Studiesmentioning

confidence: 99%

“…A study (16) evaluated the elapsed time between ingestion and emesis and compared it to mean 4-hour acetaminophen concentrations. Those who experienced emesis within 90 minutes of ingestion had a lower mean serum acetaminophen concentration (15.7 -19.9 mg/L) than those in the nondecontamination group (33.1 mg/L) even though the estimated quantity ingested was greater.…”

Section: Acetaminophen (Paracetamol)mentioning

confidence: 99%

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Position Paper: Ipecac Syrup

Toxicologists¹

2004

Journal of Toxicology: Clinical Toxicology

119

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Syrup of ipecac should not be administered routinely in the management of poisoned patients. In experimental studies the amount of marker removed by ipecac was highly variable and diminished with time. There is no evidence from clinical studies that ipecac improves the outcome of poisoned patients and its routine administration in the emergency department should be abandoned. There are insufficient data to support or exclude ipecac administration soon after poison ingestion. Ipecac may delay the administration or reduce the effectiveness of activated charcoal, oral antidotes, and whole bowel irrigation. Ipecac should not be administered to a patient who has a decreased level or impending loss of consciousness or who has ingested a corrosive substance or hydrocarbon with high aspiration potential. A review of the literature since the preparation of the 1997 Ipecac Syrup Position Statement revealed no new evidence that would require a revision of the conclusions of that Statement.

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Section: Clinical Studiesmentioning

confidence: 99%

Section: Acetaminophen (Paracetamol)mentioning

confidence: 99%

Position Paper: Ipecac Syrup

Toxicologists¹

2004

Journal of Toxicology: Clinical Toxicology

119

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“…Bond et al (48) reviewed records of 455 patients from 11 poison centers who had ingested acetaminophen. Of these, 85 patients received no gastrointestinal decontamination and served as control.…”

Section: The Amount Of Materials Removed By Ipecac-induced Emesis-clinmentioning

confidence: 99%

Guideline on the Use of Ipecac Syrup in the Out-of-Hospital Management of Ingested Poisons

Manoguerra

Cobaugh

t³

2005

Clinical Toxicology

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The use of gastric emptying techniques, including ipecac-induced emesis, in the management of poisoned patients has declined significantly in recent years. Historically, poison centers used ipecac syrup in two ways. Ipecac syrup was administered to patients prior to referral to the emergency department in attempts to start the gastric emptying process as early as possible. Additionally, poison centers used ipecac syrup in attempts to keep patients from requiring referral to medical facilities. In these situations, ipecac syrup was administered in the home and poison center staff performed follow-up telephone calls to gauge progress and outcome. Studies to determine the effectiveness of ipecac syrup demonstrate that it induces vomiting in a high percentage of people to whom it is administered and that it decreases the gastrointestinal absorption of ingested substances in a time-dependent fashion. However, the effectiveness of ipecac syrup in affecting patient outcome has not been studied in adequate clinical trials. Its effectiveness in preventing drug absorption has only been documented for a limited number of substances and is substantially reduced if it is given more than 30-90 minutes following ingestion of the toxic material. There are potentially significant contraindications, adverse effects and related problems associated with the use of ipecac syrup. It is the consensus of the panel that the circumstances in which ipecac-induced emesis is the appropriate or desired method of gastric decontamination are rare. The panel concluded that the use of ipecac syrup might have an acceptable benefit-to-risk ratio in rare situations in which: there is no contraindication to the use of ipecac syrup; and there is substantial risk of serious toxicity to the victim; and there is no alternative therapy available or effective to decrease gastrointestinal absorption (e.g., activated charcoal); and there will be a delay of greater than 1 hour before the patient will arrive at an emergency medical facility and ipecac syrup can be administered within 30-90 minutes of the ingestion; and ipecac syrup administration will not adversely affect more definitive treatment that might be provided at a hospital. In such circumstances, the administration of ipecac syrup should occur only in response to a specific recommendation from a poison center, emergency department physician, or other qualified medical personnel. The panel decided not to address the issue of whether ipecac should remain a nonprescription, over-the-counter product. The panel does not support the routine stocking of ipecac in all households with young children but was unable to reach consensus on which households with young children might benefit from stocking ipecac. Instead, the panel concluded that individual practitioners and poison control centers are best able to determine the particular patient population, geographic and other variables that might influence the decision to recommend having ipecac on hand.

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“…7 The amount of a substance removed from the stomach is inversely related to the duration of time from its ingestion to emesis. 11 There are data from adult volunteers that show ranges of 51% to 83% removal of the poisonous substance when ipecac is given at 5 minutes 10,12-15 and of 2% to 59% when it is given at 30 minutes 10,12,13 after drug ingestion. The most relevant study 8 involved 13 children who were given ipecac as treatment for the ingestion of a potentially toxic amount of a drug.…”

Section: Ipecacmentioning

confidence: 99%

Poison Treatment in the Home

2003

Pediatrics

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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.

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Influence of time until emesis on the efficacy of decontamination using acetaminophen as a marker in a pediatric population

Cited by 41 publications

References 26 publications

Position Paper: Ipecac Syrup

Position Paper: Ipecac Syrup

Guideline on the Use of Ipecac Syrup in the Out-of-Hospital Management of Ingested Poisons

Poison Treatment in the Home

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