Schiff R J, Wurzel C L, Brunson S C, Kasloff I, Nussbaum M P, Frank S D
Pediatrics. 1986 Sep;78(3):412-6.
A 17-year-old girl presented with malaise, weakness, palpitations, dysphagia, myalgias, and weight loss of 1 month's duration. Within 24 hours of admission to the hospital, she had hypotension unresponsive to medical management, intractable congestive heart failure, and arrhythmias; she died. Several empty bottles of syrup of ipecac were later found among her belongings. Syrup of ipecac is commonly used to induce emesis in patients who had ingested toxic substances. The chief pharmacologic property of this agent is due to its alkaloid component, emetine. There have been many previous reports of death due to emetine poisoning in patients receiving ipecac fluid extract and in those treated for amoebic dysentery. However, the literature cites only three case reports of fatalities secondary to chronic ipecac use as a means of losing weight. This is the first report of a death due to chronic ipecac use in an adolescent patient with bulimia. Emetine persists in the body for long periods, and in patients who have ingested it chronically, emetine is extremely toxic, specifically to cardiac smooth and skeletal muscles. With an increased awareness of the importance of weight control in the adolescent age group, the physician must carefully evaluate these patients for the use of emetics.
一名17岁女孩出现不适、乏力、心悸、吞咽困难、肌痛以及持续1个月的体重减轻。入院后24小时内，她出现了对药物治疗无反应的低血压、难治性充血性心力衰竭和心律失常，最终死亡。后来在她的物品中发现了几个空的吐根糖浆瓶。吐根糖浆常用于诱导摄入有毒物质的患者呕吐。该药物的主要药理特性归因于其生物碱成分吐根碱。此前有许多关于接受吐根流浸膏治疗的患者以及接受阿米巴痢疾治疗的患者因吐根碱中毒死亡的报道。然而，文献中仅引用了3例因长期使用吐根作为减肥手段而导致死亡的病例报告。这是第一例因长期使用吐根导致患有贪食症的青少年患者死亡的报告。吐根碱在体内会长期存留，对于长期摄入它的患者，吐根碱具有极高的毒性，尤其是对心脏平滑肌和骨骼肌。随着对青少年年龄组体重控制重要性的认识不断提高，医生必须仔细评估这些患者使用催吐剂的情况。
