vomiting when children ingest something poisonous. The antidote, made from roots of the tropical ipecac plant, induces vomiting. In the past, recommendations for using ipecac had been based more on intuition rather on than any hard evidence that home use is effective. Although earlier recommendations advised parents to call a doctor or poison control center before using the syrup, parents have not always heeded that advice. Too often, parents used ipecac inappropriately.

Scientific advisers to the U.S. Food and Drug Administration (FDA) recommended in June 2003 that the agency end over-the-counter sales of ipecac. A final FDA decision was expected in 2004.

Poison-control centers have been phasing out ipecac because it sometimes caused prolonged vomiting and lethargy similar to drowsiness that could have been caused by an overdose of sedative pills. Those symptoms can complicate diagnosis and treatment. It also may not totally empty the stomach of poison, or may linger and cause a child to vomit up other antidotes.

Another study found that home use did not reduce emergency room visits and did not improve outcomes. It is based on an analysis of data from the American Association of Poison Control Centers, which also is preparing new ipecac guidelines.

Ipecac syrup that has not expired does not need to be thrown out, but parents should not use ipecac before consulting a physician. Alternative home treatments for poisoning, such as activated charcoal or natural products, have not been shown to be effective, and in some cases are not safe or feasible to administer. Because of this, the American Academy of Pediatrics does not recommend using these products at home.

In any case, charcoal is harder for parents to administer than ipecac, because children object to the tasteless, gritty solution. For this reason, many experts believe there is still a place for syrup of ipecac in the home, although it must always be given with poison control center guidance.

While the correct dosage should be prescribed by a doctor or poison control center, a typical dose for a child over age one is two tablespoons followed by at least two to three glasses of water—not milk. If the child has not vomited within 20 minutes, the dose may be repeated. If the child still does not vomit, the poison control center should be called for further instructions.

If possible, the child should vomit into a container so that the material can be identified by medical experts at a hospital. Vomiting is effective only if it occurs within four hours of ingestion of a solid substance, or within two hours of ingestion of a liquid.

iron Dietary supplements containing iron (ferrous sulfate, ferrous gluconate, ferrous fumarate) are commonly given to children as part of a daily vitamin, but it is an often-overlooked potential source of poison to youngsters.

An accidental overdose of iron can damage the stomach, liver, and small intestine, affect blood circulation, and lead to shock and even death. Young children have been seriously injured by swallowing doses of 200 mg to 400 mg of iron, equivalent to 14 to 27 children's vitamin-and-mineral supplements with iron—or just four to seven tablets of a typical adult iron supplement.

More than 2,000 people are poisoned each year with iron, and a large number of those poisonings are fatal. Mortality may be as high as 50 percent.

In 1997 the U.S. Food and Drug Administration ruled that packages of all preparations that contain iron must now display a warning that accidental overdose of these products is a leading cause of fatal poisoning in children under age six. In addition, products containing 30 mg or more of iron per unit must be packaged as individual doses that will limit the number of pills or capsules a small child could swallow.

Despite resistant packaging, accidental overdose of iron remains a leading cause of poisoning deaths in children under age six. Since 1986 more than 11,000 incidents of children ingesting iron have been reported, and 35 children have died. Most of the serious injuries have occurred with products having more than 30 mg of iron per dosage unit. This includes most prenatal iron products, which are likely to be found in households with young children.

The exact mechanism behind iron poisoning is not known, nor is it understood how death results—whether from shock, systemic effects, or from the metabolic effects of absorbed iron, which causes respiratory collapse.

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