Gastric rupture and death caused by ipecac syrup

We have reported a fatal complication of a therapeutic dose of ipecac syrup administered in a hospital emergency room. This child received 15 ml of ipecac syrup shortly after ingesting one to five tablets of chlorpheniramine maleate (4 mg). A prolonged course of vomiting (more than 24 hours) eventually resulted in gastric rupture and death. While the use of ipecac is both efficacious and safe in the overwhelming majority of cases, there have been documented fatalities after appropriate doses. For this reason, ongoing education for physicians is important; education of parents is also warranted since wide-scale distribution to families is the accepted standard. Because most patients stop vomiting within two to three hours after ipecac administration, we recommend that children with persistent vomiting should be observed in a medical facility, where electrolyte levels can be measured and fluids can be replaced if necessary.