Guess what? A patient’s grandmother taught me this week that something I learned in residency is completely obsolete. AWESOME!
When I was a resident I was taught to advise parents to have syrup of ipecac in the medicine cabinet in case their child swallows a poison. I was taught to tell parents never to USE it unless told to do so by Poison Control, and to have the Poison Control phone number posted by the phone and easy to find.
What is syrup of ipecac? It is a liquid medicine that reliably makes people vomit. The point of having it ready in the house is that if you need it, that’s not when you want to be heading to the pharmacy to buy it. If you need it, you need to use it NOW.
My patient’s grandmother listened carefully to my advice and then headed to the pharmacy to buy syrup of ipecac. Guess what she found? It’s not on the market anymore. Not produced anymore. Hasn’t been available for years.
What?! Well I’m nothing if not willing to admit I might be wrong. However, before changing the advice I give parents I wanted to look and see what the rationale was behind the change, and find out what I AM supposed to tell parents to do in case their child swallows a poison.
There are 3 main reasons why the use of syrup of ipecac is no longer recommended. First of all it is not very effective. It is pretty reliable at causing vomiting, but it generally does not completely empty the stomach. If your child has swallowed a poison you want to get rid of ALL of it, right?
Second, it could cause more damage if used improperly. There are poisons that do as much or more damage coming up than they did going down in the first place. I would always tell parents NEVER to use syrup of ipecac without specific instructions from Poison Control, but I can see how a panicky parent might just reach for ANY remedy without making that all-important phone call.
Third, syrup of ipecac has the potential to be abused. Patients with bulimia are known to use it to make themselves vomit. Repeated abuse of ipecac can cause heart problems and trouble with the salts in the bloodstream. Also, there is a terrible (but thankfully rare) mental illness called Munchausen syndrome where people deliberately cause themselves to be ill. Some people are seeking attention or malingering. In a truly horrible variant of this called Munchausen syndrome by proxy, parents or other caregivers cause illness in those under their care. Ipecac was one substance frequently used to cause illness in these cases. Taking it off the market takes it out of the hands of those who would choose to use it to hurt themselves or someone else.
So what should parents do in case of an accidental poisoning at home? Please remember that the most important aspect of treating poisoning is not letting it happen in the first place. Keep all cleaning products, household chemicals and medications locked up and secure. Even vitamins should be kept out of children’s reach.
If your child gets into something and swallows a substance, and you’re not sure if it might be poisonous, the first thing to do is to call the National Poison Control number at 1-800-222-1222. The experts will help figure out what your next step should be.
I just called and double-checked the number is still right (and it is). I also have my own Poison Control story. My oldest child got into his father’s underarm deodorant when he was a toddler and took a couple of bites. (Why he didn’t stop after one bite is a mystery, that stuff CAN’T taste good!) The Poison Control guy was so nice and supportive. I suppose they get a lot of calls from moms who feel like they’ve lost their chance at Mother of the Year, right?
After looking up the active ingredient and making sure it wasn’t toxic, he laughed with me gently and reassured me that they get lots of those calls and mine certainly wasn’t the first child to develop a taste for deodorant.
What do you do if you have a 13-year-old bottle of syrup of ipecac sitting in your medicine cabinet? Give that bottle the honorable burial it deserves, in the trash can.
Thank you Connie for letting me know what the pharmacist told you when you went looking for syrup of ipecac at the drugstore. You’ve given me a great chance to improve my practice and give my patients the most up-to-date information.
They told me in medical school that 50% of what they were going to teach us was wrong. It’s up to us to keep reading, keep researching and keep learning to figure out which 50% it is!
QUESTION: Do you (or did you) have syrup of ipecac in your house?