Clinical and Pathologic Aspects of Cardiomyopathy From Ipecac Administration in Munchausen's Syndrome by Proxy

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.