Poisoning in Munchausen Syndrome by Proxy, Part 4: Ipecac Poisoning

In my previous posts, I talked about the top two most popular methods of poisoning in Munchausen Syndrome by Proxy (MSbP): tranquilizer/anti-depressant poisoning, and insulin poisoning. In this post, I’ll talk about the third more population type of MSbP poisoning: ipecac poisoning.

Goanese Ipecac

The goanese ipecac plant.

What is Ipecac Anyway?

Ipecac is a syrup made from the ipecac plant that parents were supposed to keep at home in the olden days to induce vomiting in children in case they ate something they shouldn’t (like poison). However, as it turns out, it doesn’t work. According to the 1997 position statement on ipecac syrup by the American Academy of Toxicology and the European Association of Poisons Centres and Clinical Toxicologists:

“Syrup of ipecac should not be administered routinely in the management of poisoned patients…There is no evidence from clinical studies that ipecac improves the outcome of poisoned patients and its routine administration in the emergency department should be abandoned”.

The emergency department may have abandoned ipecac, but it remained a favorite among MSbP perpetrators.

Cardiomyopathy as a Result

Unfortunately, overdosing on ipecac causes cardiomyopathy, or weakening of the heart muscles. Although there were several articles on ipecac poisoning getting to this extreme state before toxicology to look for ipecac was undertaken, the most recent one we found is from 2006. The reason ipecac poisoning is less common now is that it’s harder to get. However, since ipecac is a natural element, it is still available homeopathically online at, for example, Amazon.com.

Symptoms of Ipecac Poisoning

The symptoms are what you’d expect after taking an emetic, or something that induces vomiting: vomiting and diarrhea. In one case, an 18-month-old (whose mother was a pediatric nurse) was admitted to the hospital and endured 25 days of vomiting and diarrhea until they did toxicology and figured out the mom was doing it.

“A urine drug screen showed emetine – the active constituent of syrup of ipecacuanha (ipecac). A search of his bedside locker revealed a bottle of ipecac in his mother’s purse. The vomiting and diarrhoea ceased immediately after her access was restricted.”

Purse from Hyderabad

Recognizing Ipecac Poisoning

Ipecac poisoning is not as common anymore, but it should be immediately suspected with intractable vomiting. Toxicology could immediately answer this question and rule out cycling vomiting syndrome or cannabinoid hyperemesis syndrome.

In my next post, I will talk about a few other types of MSbP poisoning I came across in my review of 87 articles.

Did you know that ipecac also is a problem for people suffering from bulimia?

Read about it here.

Photographs by Ajaykuliloor and Adityamadhav83.

Advertisements

6 thoughts on “Poisoning in Munchausen Syndrome by Proxy, Part 4: Ipecac Poisoning

  1. I should add, btw, I don’t go around tasting dark corn syrup, but its use as a sweetener in candies and so on is why I don’t eat those things, or eat pecan pie, etc. Hidden blessing?

    Like

  2. To be honest, this is probably its own blog post on ipecac.
    Personal observation: The taste really is… hidden. Easily hidden? Hard to find? If you put it into something pungent or spicy, I doubt anyone would notice at all, based on my memory. It does *not* taste like sugar, but more like… wildflower honey? A dark honey? This sounds nuts, but dark corn syrup can make me reflexively guzzle water to get rid of the taste, so that might be an equivalent, at least in my imperfect taste-memory.

    My mom told me back then, the syrup was sweet, so you could get someone to take it back when it was medicinal (according to my mother, who was a nurse when ipecac was still sometimes used to induce vomiting in poisoning cases). I’ve no idea if the substance is naturally sweet or not.

    That said, and this is where it gets creepy… My dad always complained that my mother’s cooking didn’t taste as *sweet* as his mother’s. (That’d be MSbP lady.) He would urge my mother to add sugar to spaghetti sauce, didn’t htink she bought the right pancake syrup because it wasn’t as sweet, it was an ongoing thing the first years of their marriage that both of them complained about decades later. Obviously, since I heard about it!

    My dad and his siblings have all had GI issues all their lives, and to some extent it could be genetically influenced. On the other hand, all 7 of 7 kids is statistically getting toward that territory of “improbable”.

    In the incident above, the mac-and-cheese we ate was, in fact, somewhat sweet, though I can’t quite describe how. It was one reason why I ate less than I normally might have. My mom’s mac-and-cheese never tasted that way. (Nor does mine.) My dad argued that his mother always “sweetened the pasta water and pasta sauce”, when I asked him why he was complaining about *my* mother’s cooking. Now, I’ve heard of salting the water, but never sugaring it.

    The sweetish taste was hidden under an incredibly amount of cheese, so I’d sort of catch it, then it’d be gone. I just knew eating wasn’t making me feel well, and then I was really ill. In the interest of clarity, I recently (yesterday) asked my mother about this incident, and she said she thought ipecac not only because of our symptoms, but also because my sister had put ketchup on the mac-and-cheese to “make it taste better”. That was highly unusual, as ketchup on mac-and-cheese was *never* something she’d done at home. Or was ever known to do, in my knowledge of her.

    My mom sees no point in dredging up “ancient history”, so I doubt I can get more information than that. Everyone else involved is dead, unreliable due to abuse of drugs / alcohol, or insists (this would be a paternal relative with whom I e-mail) no one would do such things on purpose.

    Like

    • Wow! This is really interesting. I’ll have to really ponder this. Yes, I think it does deserve a blog post if you feel like writing one. I am wondering – if a lot of people are dosed with the same amount of ipecac, do they all get sick? My brother and I would eat the same mac and cheese (weird coincidence with your story!) but he would throw up and I wouldn’t, but I was 5 years older and bigger. Also, maybe some people don’t respond to it….? Thank you for your insight.

      Like

      • As it happens, my sister was five years older, bigger, heavier, and while she was cramping and vomiting, she didn’t have the feverish high-heart-rate feelings I did. So it could have something to do with weight, metabolism, who knows?

        Like

  3. My gran used that on her grandkids once. We were unhappy campers, and very ill. My mother never let us eat anything she gave us again, unless she was present. Words can’t describe what an adult dose of ipecac does to a five-year-old. Horrifying. Gran wanted to play “savior caretaker”, but we only wanted to go home. It’s insidious stuff, when used, IMO.

    Like

    • That is awful to hear. I’m so sorry, what a horrible experience. What does ipecac taste like? Did you guys notice it in the food that was poisoned with it when you were eating it? What food did she mix it in? I don’t think I got it but my brother threw up all the time and now I’m wondering why, so any advice would be very helpful to me. Thank you!

      Like

Please reply!

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s