Emeticsinducing Vomiting

When a patient ingests a toxic substance, it is critical that the toxin be expelled or neutralized before the body can absorb it. However, vomiting should not be induced if the toxin is a caustic substance such as ammonia, chlorine bleach, lye, toilet cleaners, or battery acid. Regurgitating these substances can cause additional injury to the esophagus. Vomiting should also be avoided if petroleum distillates are ingested. These include gasoline, kerosene, paint thinners, and lighter fluid.

In cases where vomiting is contraindicated, the patient should be administered activated charcoal, which is available in tablets, capsules, or suspension. Charcoal absorbs (detoxifies) ingested toxic substances, irritants, and intestinal gas. Activated charcoal can be given as a slurry (30 grams in at least 8 oz. of water) or 12.5-50 grams in aqueous or sorbitol suspension. It is usually given as a single dose.

In cases where vomiting is desired, use one of two ways to expel a toxin:

The nonpharmacological treatment is to induce vomiting by stimulating the gag reflex by placing a finger or a toothbrush in the back of the patient's throat.

Pharmacological treatment involves administering an emetic to induce vomiting. Ipecac is the most commonly used emetic. Ipecac, available over the counter, should be purchased as a syrup—not a fluid extract. The syrup induces vomiting by stimulating the CTZ in the medulla and acts directly on the gastric mucosa.

Ipecac should be taken with at least eight or more ounces of water or juice (do not use milk or carbonated beverages). If vomiting does not occur within 20 minutes, then the dose should be repeated. If vomiting cannot be induced, then administer activated charcoal. The absorption of ipecac is minimal. Protein-binding is unknown and the half life is short. Duration of action is only 20-25 minutes. Do not attempt to induce vomiting if the patient is not fully awake and alert.

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