PEDIATRICS Vol. 97 No. 6 June 1996, pp. 902-906
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Clinical and Pathologic Aspects of Cardiomyopathy From Ipecac Administration in Munchausen's Syndrome by Proxy

Douglas J. Schneider MD1, Angel Perez MD1, Timothy E. Knilans MD1, Stephen R. Daniels MD, PhD1, Kevin E. Bove MD2, and Harry Bonnell MD3

1 Division of Cardiology, Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229
2 Department of Pediatrics, Department of Pathology, Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229
3 Hamilton County Coroner's Office, Cincinnati, OH 45229

Syrup of ipecac is an important component of the emergency management of acute toxic ingestion in children. It is generally safe for acute emergency use, and is recommended for first aid kits in homes with children. However, there are important toxic effects of excessive or long-term ingestion of syrup of ipecac. Cardiomyopathy is a potentially fatal, but often reversible, toxic manifestation of ipecac abuse, most commonly occurring in patients with bulimia. Another setting in which ipecac abuse occurs is Munchausen's syndrome by proxy. We report two cases, one fatal, of cardiomyopathy from ipecac toxicity secondary to Munchausen's syndrome by proxy.

Submitted on October 19, 1994
Accepted on June 28, 1995




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