Pneumomediastinum and retropneumoperitoneum: An unusual complication of syrup-of-ipecac-induced emesis

doi:10.1016/S0196-0644(84)80341-8

Annals of Emergency Medicine

Volume 13, Issue 12, December 1984, Pages 1148-1151

https://doi.org/10.1016/S0196-0644(84)80341-8 Get rights and content

A young woman returned to the emergency department two hours after discharge because of persistent vomiting and chest pain. Six hours earlier she had received syrup of ipecac to induce emesis following a drug overdose. Radiologic examination in the emergency department revealed pneumomediastinum and retropneumoperitoneum. A nasogastric tube was inserted in the emergency department. The patient was admitted to the ICU and placed on prophylactic antibiotics. Barium and gastrograffin esophagrams revealed no evidence of extravasation. Gastrointestinal endoscopy showed distal esophagitis. Gastroscopy and duodenoscopy were unremarkable. The patient did well following discharge.

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Cited by (30)

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To review and address the abuse of ipecac, describing its epidemiology, toxicity, clinical characteristics, and laboratory assessment.
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Ipecac abuse occurs predominantly among adolescent and young adult females who are either experimenting with purging or have an eating disorder. Psychiatric comorbidity is common. Death can occur and is usually of cardiac origin. Morbidity includes myocarditis with arrhythmias, myositis, gastroesophageal pathology, including Mallory Weiss tears, diarrhea, and metabolic abnormalities (alkalosis, hypokalemia, dehydration). The injuries can reverse with cessation of ipecac use. A high index of suspicion is needed for early detection. Classic findings are abnormal EKG and echocardiography and/or elevation of muscle enzymes (CPK, adolase). Emetine, the alkaloid in ipecac, can be confirmed in serum, urine, and tissue by high performance liquid chromatography.
Ipecac abuse is dangerous, even deadly. However, if abuse is discontinued, cardiac and muscle damage tends to reverse. Were ipecac syrup to remain an over- the-counter medication, or become a prescription medication, more stringent warning labels ought to be included and further education be provided about its toxicity and potential for abuse. Removing ipecac from the over-the-counter category would best eliminate its potential for abuse.
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Routine poison management involves the following: (1) stabilization, (2) toxidrome recognition, (3) decontamination, (4) antidote administration, (5) enhanced elimination of toxin, and (6) supportive care. Stabilization involves airway, ventilation, and circulation support. In the patient with altered mental status, oxygen, naloxone, glucose, and thiamine should be administered. Symptom complexes that relate to specific classifications of toxins are referred to as toxidromes. Emesis by means of syrup of ipecac is rarely used for in-hospital gastric decontamination. Activated charcoal is a useful adsorbent for gastric decontamination. Whole bowel irrigation is useful for iron, lead, and lithium poisoning and for the body packer phenomenon. Enhancement of elimination may involve multiple doses of activated charcoal, hemodialysis, or charcoal hemoperfusion.
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L'évacuation du contenu gastrique, suivie par l'administration de charbon adsorbant et de laxatifs, est souvent recommandée et pratiquée de façon systématique dans les ingestions toxiques aiguës, en dehors de quelques contre-indications reconnues. Bien que son influence sur l'évolution clinique n'ait jamais été clairement démontrée, le charbon adsorbant, administré précocement, permet de réduire la biodisponibilité de nombreux toxiques. Comme il est pratiquement dépourvu d'effets secondaires, une large utilisation semble raisonnable. Par contre, l'induction de vomissements et le lavage gastrique, dont l'utilité est douteuse, même sur le plan toxicocinétique, sont des techniques parfois associées à des complications graves. Une utilisation moins systématique et plus rationnelle devrait donc en être faite. Cet article, publié en deux parties, est une revue de la littérature destinée à guider les choix thérapeutiques du clinicien.
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Case reportPneumomediastinum and retropneumoperitoneum: An unusual complication of syrup-of-ipecac-induced emesis

Lancet

Lancet

Ann Emerg Med

Ann Thorac Surg

Ipecac poisoning

West J Med

Syrup of ipecac: A drug review

Clin Toxicol

Death resulting from ipecac syrup poisoning

JAMA

Toxicology of ipecac: A review

Clin Toxicol

Case report
Pneumomediastinum and retropneumoperitoneum: An unusual complication of syrup-of-ipecac-induced emesis