The first 5 years I worked at the IPC, I was a CSPI and answered calls from the general public and health care professionals. I would always joke with my fellow CSPIs that we used the word ‘vomit’ more times in a day than most people probably do in a lifetime: “Has he had any vomiting?” “Symptoms to watch for include vomiting…” “How many times did she vomit?” “If you see excessive vomiting, call us back” and, the most pertinent to this post, “DO NOT induce vomiting”.For many years, causing someone to vomit was considered to be a mainstay in the treatment of an ingested/swallowed poison. Syrup of ipecac (an emetic) was the standard medicinal way of doing so, but at-home, do-it-yourself (and potentially dangerous) methods have included the old ‘finger down the throat’, mustard mixed with milk, salt water, baking soda and even butter or raw eggs.
The rationale for inducing vomiting seems logically sound: if someone swallowed something potentially toxic, just bring it right back up and out, removing the substance from the stomach and thus eliminating the need for the person to be in the hospital. In practice however, it does not work this way. Not only does inducing vomiting not help, many times it can actually do more harm than good. Here’s the scoop:
- Inducing vomiting will not prevent someone from needing evaluation in a health care facility (if the quantity/type of substance ingestion would have warranted this to begin with). Conventional wisdom is that vomiting removes the entire stomach contents. However, volunteer and animal studies have shown that when vomiting is induced by syrup of ipecac, only 17.5-83% of stomach contents are removed. Exactly how much is removed is extremely variable, and the longer after the ingestion (i.e. even as long as only 10-30 minutes) the less substance that is removed.
- There are many drugs and toxins whose effects would be very dangerous when combined with vomiting. Some examples:
- The patient is, or could become (by the effects/symptoms of the substance they ingested) drowsy, unconscious, or have seizures. Someone who is having a seizure or more than a little drowsy is not able to control their airway and they can aspirate vomit into their lungs. This can cause asphyxia or pneumonia.
- The patient has ingested a caustic substance (such as an acidic cleaner, a toilet bowl cleaner, etc). The concern with these types of substances is that it can cause a chemical burn in the GI tract; if it can burn on the way down, the last thing we want to do is cause vomiting and have it burn again on the way up.
- The patient has ingested a hydrocarbon (such as lamp oil, kerosene or gasoline). We’ve talked about the dangers of aspirating hydrocarbons into the lungs before here and here. If the patient swallowed the hydrocarbon and it didn’t get into the lungs on the way down, vomiting gives it another chance to get into the lungs on the way up.
- Complications and side effects can result:
- Side effects of ipecac include diarrhea, drowsiness, aspiration and prolonged vomiting. Death has also occurred but is extremely rare. Check out this video of Family Guy’s Peter Griffin and his experience with syrup of ipecac. <Warning: It’s pretty gross!>
- Forcing a finger or other object into the back of the throat in an attempt to induce vomiting can injure this part of the body. We had a case once where someone poked a toothbrush handle down his throat to induce vomiting and punctured himself there. Talk about adding insult to injury.
- Using home remedies can also be extremely dangerous. Not only are they ineffective at inducing vomiting, but excessive salt or baking soda can be poisons in and of themselves.
The American Association of Poison Control Centers, The American Academy of Clinical Toxicology, and the American Academy of Pediatrics all advise against the storing and use of ipecac in the home. Two years ago, Tony wrote a post about the retirement of syrup of ipecac; it is no longer widely available (if at all) in the US. If you do have an old bottle in your medicine cabinet or first aid kit, please dispose of it properly.
Remember, never induce vomiting when someone has ingested something potentially toxic; the first thing you should do is call the IPC! 1-800-222-1222
Don’t forget to check out the “My Child Ate…” resource center which gives toxicity level and treatment information for the most common substances/products ingested by children.