A mother brings an 18-month-old to the emergency center with the concern that the child may have ingested a substance. Which of the following is a contraindication to the use of ipecac in this child?
The induction of emesis with syrup of ipecac is a very effective method of removing swallowed poisons. It has been used safely in children as young as 6 months of age. Ipecac should not be given to a patient who has ingested a corrosive poison, such as strong acid or alkali, because of the possibility of gastric perforation and fuher necrosis of the esophagus. When vomiting imposes a risk of aspiration, as in the case of an obtunded or comatose patient or in the case of impending seizures precipitated by the ingested drug, syrup of ipecac is contraindicated. Hydrocarbons such as mineral oil have a low viscosity and surface tension; the latter propey accounts for the spreading tendency of the product and the potential for aspiration. Very minute amounts of aspirated hydrocarbon can cause a necrotizing pneumonia. Syrup of ipecac should be used only when the primary toxicity of the hydrocarbon is systemic, as, for example, with carbon tetrachloride or benzene. Administration of activated charcoal alone without prior gut emptying is being used for ceain ingestions. Proper instruction of parents regarding toxic ingestions should be provided during well-child visits. Effos should be aimed at prevention, with age-appropriate anticipatory guidance regarding environmental hazards.
Age less than 5 years
Breast-feeding
Ingestion of alkali
Ingestion of iron