Nonemetic effects of ipecac syrup

The aftereffects of home-induced emesis with ipecac syrup were determined by telephone interviews of callers to a poison center. During the 12-week study, the presence of any symptoms at follow-up in 146 patients was compared with findings in 99 callers to the poison center who did not receive ipecac. Within four hours after ipecac-induced emesis, 33.6% had no symptoms and 17.1% experienced protracted emesis. In the ipecac-treated group the incidences of one formed stool (4.1%) and lethargy during a typical sleeping time (42.5%) were not significantly different from the incidences in patients not receiving ipecac syrup. The incidences of diarrhea (13.0%) and atypical lethargy (11.6%) were higher (P less than .025 and P less than .05, respectively) after ipecac-induced emesis than in patients not receiving ipecac syrup. There was no significant statistical association between the propensity of the ingested toxin to produce diarrhea or lethargy and the occurrence of diarrhea or atypical lethargy. Because ipecac-induced emesis can produce diarrhea and lethargy, these side effects should be noted and differentiated from normal conditions when ipecac syrup is administered.     

Risk assessment of ipecac in the home

To determine how frequently parents give ipecac syrup without medical consultation and what complications result from this practice, 8 months of telephone calls to a regional poison center for poisonings of children less than age 6 years (23,790 calls) and 3 years of medical records for children's poisonings from 21 hospitals (516 cases) were studied. The practice of using ipecac syrup without consultation ranged from 0.4% of poison center callers to 6.0% of hospital patients. Of the 137 parents who gave ipecac without consultation, only 4% gave ipecac syrup for a poisoning exposure for which its use was contraindicated. In one of these cases did medical complications such as aspiration, seizures, or gastrointestinal burns result. Hence, the practice of giving children ipecac syrup without medical advice was found to be relatively infrequent and rarely produced complications. The study pointed out the importance of educating parents about products for which ipecac syrup is contraindicated and about occasions when ipecac is unnecessary. In 61% of cases of poisonings, the parent gives ipecac before calling the poison center and learning that the child did not need the Ipecac. The study also suggested that improvements are needed in warning labels of particular products, and revisions and standardization of the labels found on different brands of ipecac syrup are essential for appropriate emergency care.     

Cerebrospinal fluid volume measurements in hydrocephalic rats

Object Experimental data about the evolution of intracranial volume and pressure in cases of hydrocephalus are limited due to the lack of available monitoring techniques. In this study, the authors validate intracranial CSF volume measurements within the lateral ventricle, while simultaneously using impedance sensors and pressure transducers in hydrocephalic animals. Methods A volume sensor was fabricated and connected to a catheter that was used as a shunt to withdraw CSF. In vitro bench-top calibration experiments were created to provide data for the animal experiments and to validate the sensors. To validate the measurement technique in a physiological system, hydrocephalus was induced in weanling rats by kaolin injection into the cisterna magna. At 28 days after induction, the sensor was implanted into the lateral ventricles. After sealing the skull using dental cement, an acute CSF drainage/infusion protocol consisting of 4 sequential phases was performed with a pump. Implant location was confirmed via radiography using intraventricular iohexol contrast administration. Results Controlled CSF shunting in vivo with hydrocephalic rats resulted in precise and accurate sensor measurements (r = 0.98). Shunting resulted in a 17.3% maximum measurement error between measured volume and actual volume as assessed by a Bland-Altman plot. A secondary outcome confirmed that both ventricular volume and intracranial pressure decreased during CSF shunting and increased during infusion. Ventricular enlargement consistent with successful hydrocephalus induction was confirmed using imaging, as well as postmortem. These results indicate that volume monitoring is feasible for clinical cases of hydrocephalus. Conclusions This work marks a departure from traditional shunting systems currently used to treat hydrocephalus. The overall clinical application is to provide alternative monitoring and treatment options for patients. Future work includes development and testing of a chronic (long-term) volume monitoring system.     

Past, present, and future role of ipecac syrup

Historically, ipecac syrup has played a principal role in the management of acute poisonings and overdoses. Presently, its role largely has been relegated to prompt decontamination of acute childhood poisonings for which emesis is not contraindicated. However, even this specific and limited role has undergone rigorous re-evaluation, and many toxicologists have discouraged against its use in any circumstance. This article reviews the history, scientific literature, and public health implications of ipecac syrup that support its present clinical application.     

Influence of ventilation mode on neonatal cerebral blood flow and volume

Background

Cerebral hemodynamics is supposed to be influenced by the different ventilation approach. Ventilation support can be classified as non-invasive (N-CPAP) or invasive (SIMV and HFV), the last known to induce endotrauma. Our aim was the non-invasive NIRS assessment of neonatal absolute cerebral blood flow (CBF) and relative cerebral blood volume changes (ΔCBV) during synchronized intermittent ventilation (SIMV), or high frequency ventilation (HFV) and nasal continuous positive airways pressure (CPAP).

Methods

An observational study in a tertiary referral NICU. CBF and ΔCBV changes were assessed in 41 preterm newborn infants with respiratory distress syndrome treated using mechanical ventilation or the CPAP device.

Results

Basal chromophore traces enabled ΔCBV (mL/100 g) changes to be calculated. CBF was calculated in mL/100 g/min from the saturation rise integral and rate of rise [O₂Hb-HHb]. Median ΔCBV was 0.07 (range 0.01-0.13) in SIMV group, 0.07 (0.01-0.19) in HFV group and 0.13 (0.10-1.28) in CPAP group. Median CBF was 14.44 (2.70-32.10), 9.20 (2.94-19.58) and 31.69 (13.59-34.93) respectively. A multiple regression model showed a significant correlation between ΔCBV or CBF and ventilation approach.

Conclusion

In the light of our results, we might speculate that, assuming that hemodynamic autoregulation is safe and arterial blood pressure is preserved, ventilation per se influences brain circulation.