This is the current release of the guideline.

Grades of recommendation (A-D, Z) and levels of evidence (1a-6) are defined at the end of the "Major Recommendations" field.

Summary of the Quality of the Evidence

1. Syrup of ipecac induces vomiting in almost all people to whom it is administered (Grade A evidence).
2. Ipecac-induced emesis decreases the gastrointestinal absorption of ingested substances although to varying, unpredictable extents (Grade A and B evidence).
3. The longer the interval between ingestion of the substance and the administration of ipecac syrup, the less the effect. This has been documented for a limited number of substances and the effectiveness in removing ingested materials declines rapidly with time and is substantially reduced after 30 to 90 minutes (Grade A, B and C evidence).
4. The effectiveness of ipecac syrup in affecting patient outcome has not been studied in adequate clinical trials (No evidence).
5. The rate of hospitalization of patients with moderate or severe poisonings in whom ipecac has been administered has not been studied (No evidence).
6. The use of ipecac syrup to induce vomiting is associated with uncommon, serious adverse effects (Grade C evidence).
7. Patients with eating disorders have abused ipecac syrup. This abuse has led to significant morbidity and mortality (Grade C evidence).

Conclusions of the Consensus Panel

The panel reached consensus 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 to 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.

Definitions:

Grades of Recommendation and Levels of Evidence

None provided

The evidence supporting the conclusions of the consensus panel is identified and graded (see "Major Recommendations").

Not applicable: The guideline was not adapted from another source.

2004

American Association of Poison Control Centers - Professional Association

Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services

Guidelines for the Management of Poisonings Consensus Panel

Primary Authors: Anthony S. Manoguerra, PharmD, DABAT, FAACT; Daniel J. Cobaugh, PharmD, DABAT

Panel Members: E. Martin Caravati, MD, MPH, Medical Director, Utah Poison Control Center, Salt Lake City, UT; Gwenn Christianson, RN, MSN, Certified Specialist in Poison Information, Indiana Poison Center, Indianapolis, Indiana; Richard C. Dart, MD, PhD, Medical Director, Rocky Mountain Poison and Drug Center, Denver, Colorado; Daniel C. Keyes, MD, MPH, Medical Director, North Texas Poison Center, Texas Poison Center Network, Dallas, Texas; Anthony S. Manoguerra, PharmD, Director, California Poison Control System, San Diego Division, San Diego, California; Michael A. McGuigan, MD, CM, MBA, Medical Director, Long Island Regional Poison and Drug Information Center, Mineola, New York; Kent R. Olson, MD, Medical Director, California Poison Control System, San Francisco Division, San Francisco, California; Paul M. Wax, MD, Banner Health System, Phoenix, Arizona

Not stated

This is the current release of the guideline.

None available

None available

This NGC summary was completed by ECRI on October 27, 2005. The information was verified by the guideline developer on November 28, 2005.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.