![]() ![]() Although widely employed, there is no evidence that gastrointestinal decontamination and multiple-dose activated charcoal improve the outcome of poisoned patients. SUMMARY OF THE FINDINGS: Acute toxic exposure in children is a common event, mainly in children under six years of age. SOURCES OF DATA: MEDLINE review (emphasis on the past decade), including the American Academy of Clinical Toxicology and the European Association of Poison Centres and Clinical Toxicologists' position statements and position papers (peer-reviewed information based on scientific evidence and broad consensus) on gastrointestinal decontamination, multiple-dose activated charcoal and urine alkalinization. OBJECTIVE: To review the literature on acute toxic exposure in children, excluding envenomations. 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. ![]() 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. ![]() The panel decided not to address the issue of whether ipecac should remain a nonprescription, over-the-counter product. 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 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. 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. There are potentially significant contraindications, adverse effects and related problems associated with the use of ipecac syrup. 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. However, the effectiveness of ipecac syrup in affecting patient outcome has not been studied in adequate clinical trials. ![]() 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. In these situations, ipecac syrup was administered in the home and poison center staff performed follow-up telephone calls to gauge progress and outcome. Additionally, poison centers used ipecac syrup in attempts to keep patients from requiring referral to medical facilities. 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. Historically, poison centers used ipecac syrup in two ways. The use of gastric emptying techniques, including ipecac-induced emesis, in the management of poisoned patients has declined significantly in recent years. ![]()
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