Suspected Poisoning? Syrup of Ipecac Not Always the Answer
Contributed by: Tammy Stack, Pharm.D. Candidate
                       KU School of Pharmacy

Volume 2, Issue 8

February 2004

Parents everywhere take precautions to be sure their children don't eat or drink anything poisonous.  In 1970, the Poison Prevention Packaging Act (PPPA) was passed to protect consumers from accidental poisonings.  By regulating the use of safety closures and labels, the act covers some cleaning products, all prescription drugs, and some over the counter medications.  Pharmacy customers may be familiar with the child protection safety caps found on most medications.  Since the act was enacted, childhood poisonings have decreased.  For more information about the PPPA, visit the website: http://depts.washington.edu/hiprc/childinjury/topic/poison/packaging.htm .   However, accidental poisonings do occur, and parents need to be prepared to respond appropriately.

The most frequent exposure to poison includes cleaning substances, analgesics(pain relievers), cosmetics, cough and cold products, bites from spiders and snakes, pesticides, foreign bodies, topicals, food products and poisons, and hydrocarbons.  Most frequently ingested substances that bring people to the ER include alcohol and drugs, cocaine, opiates, acetaminophen (Tylenol), aspirin, marijuana, alprazolam (Xanax), ibuprofen (Motrin or Advil), diazepam (Valium), or amitriptyline (Elavil).

Not all ingestions require a trip to the ER.  If there is suspicion of poisoning in a child or adult, first check for the ABCs of life support:  is there any Airway obstruction, any Breathing problems, or any Circulation problems?  If the patient's status is life-threatening, begin basic life support and call 911 immediately.  If the patient is stable, call your local poison control center after collecting as much the following information as possible: the substance thought to be ingested; the amount of time since ingestion; the amount ingested; any signs

and symptoms; age; weight; general medical condition of the patient; any allergies; and any social, psychiatric, or medical history pertinent to the patient. Make a note of the vital signs of the patient: any increase or decrease in heart rate, breathing, or temperature.

The number for the Kansas Poison Control Center is 1-800-332-6633, located at the University of Kansas Hospital. The poison center has pharmacists on staff 24 hours a day to assist with questions and medical advice in the treatment of accidental poisonings. You can find more information about the Kansas Poison Control Center at their website:  www.kumc.edu/poison/firstaid/.

In the past, parents have been quick to administer syrup of ipecac to induce vomiting in suspected poisonings.  However, in 2003, the American Academy of Pediatrics announced its new policy that syrup of ipecac should not be used routinely.  In some cases vomiting may cause even more problems such as damage to the esophagus or aspiration of toxic substances into the lungs.  Before considering its use, please contact your physician or the poison control center.

Since any substance can be toxic at a given dose and route of administration, it is important to contact a health care professional in response to a suspected poisoning. The practitioner can provide information about the suspected toxin, treatment options, and comfort to a worried parent or caregiver.

Co-edited by:
Sarah Kerner, Pharm.D.
Miranda Wilhelm, Pharm.D.
John Witt, Pharm.D.

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