Should home Ipecac-induced emesis be routinely recommended in the management of toxic berry ingestions?

Poison center (PC) management of toxic berry ingestions may include recomme ndations to administer syrup of ipecac (SI) regardless of the number of ber ries ingested. We investigated whether the routine use of SI in the home ma nagement of asymptomatic single or few (<6) berry ingestions may be unneces sary. A prospective, randomized clinical trial compared SI + home observati on (HO) to HO alone for management of pediatric toxic berry ingestions. Sub jects were children 9 mo to 5 y who ingested a small number (<6) of Taxus s p (yew), Solanum americanus (nightshade), Ilex sp (holly) or unknown potent ially toxic berries. Exclusions were symptomatic subjects, ingestion of mor e than 1 type of berry or other plant part, or contraindication to SI. Outc ome variables consisting of symptom assessment and disposition were assesse d 24 h following the ingestion. Over a 27-mo period 103 subjects were enter ed into the study; 45 received SI/HO and 51 received only HO. While 100% of the SI/HO group experienced vomiting, none of the HO group vomited, Diarrh ea and sedation were more common in the SI/HO group. Use of SI in the home management of young children who ingest fewer than 6 toxic berries (yew, ni ghtshade, holly or unknown) and who are asymptomatic when the PC is contact ed may be responsible for the majority of symptoms. Ingestion of small amou nts of berries mat require no intervention beyond observation. Methodologic al limitations of this study included the lack of confirmed identification of the berries and the inability to confirm ingestion and absorption.