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Influence of time until emesis on the efficacy of decontamination using acetaminophen as a marker in a pediatric
G R Bond1, R K Requa, E P Krenzelok
1Samaritan Regional Poison Center, Phoenix, Arizona.
Insights
Emesis, or induced vomiting, can reduce acetaminophen levels by half if performed within 30 minutes of ingestion. Delayed emesis significantly reduces its effectiveness in drug removal.
Area of Science:
- Toxicology
- Emergency Medicine
- Pharmacology
Background:
- Poisoning management often involves decontamination procedures.
- Emesis (induced vomiting) has been a traditional method for reducing drug absorption.
- The efficacy of emesis is influenced by the timing of administration after toxic substance ingestion.
Purpose of the Study:
- To evaluate the effectiveness of emesis in removing acetaminophen.
- To determine how the time elapsed since ingestion affects drug removal by emesis.
Main Methods:
- A multicenter retrospective chart review was conducted.
- Data from 455 children who ingested acetaminophen were analyzed.
- Serum acetaminophen concentrations were measured 4 hours post-ingestion, correlating with decontamination timing.
Main Results:
- Emesis within 30 minutes of acetaminophen ingestion reduced serum concentrations by approximately 50% compared to no decontamination.
- The impact of emesis diminished significantly when delayed beyond 30 minutes.
- Emesis showed no demonstrable benefit when performed more than 90 minutes after ingestion.
Conclusions:
- Emesis is most effective for acetaminophen overdose when administered very early (within 30 minutes).
- Delayed emesis has limited value in reducing the toxic burden.
- Clinical decisions regarding emesis should consider timing and potential impact on patient outcomes.
Study Objective:
To determine the extent of drug removal by emesis at different times after the ingestion of a toxic substance.
Design:
Multicenter retrospective chart review.
Methods:
Using the American Association of Poison Control Centers' aggregate data base, children who had ingested acetaminophen and who were referred to a health care facility by one of 11 poison centers during a two-year period were identified. Charts of these patients were reviewed to determine the quantity ingested per kilogram of body weight, method of decontamination used, the timing of decontamination, and the serum acetaminophen concentration obtained four hours after ingestion.
Result:
Charts of 455 patients met all requirements for inclusion. When emesis occurred within one-half hour after ingestion, mean serum acetaminophen concentration drawn four hours after ingestion was approximately half that in a control group that received no decontamination. Emesis had less impact when it was delayed further and had no demonstrable impact when it occurred more than 90 minutes after ingestion.
Conclusion:
Many factors must be considered when deciding if and by what method a given patient should receive decontamination. When delayed gastric emptying is not expected, emesis can at best decrease a toxic burden by half if it occurs early. Medical care givers must continue to scrutinize management practice to ensure that syrup of ipecac is given only in situations in which it is likely to make a difference in outcome and in which it is the most effective agent to achieve this goal.