Urinary excretion of ipecac alkaloids in human volunteers.

Limited data are available regarding urinary excretion of ipecac alkaloids in humans. In this study, ipecac syrup was administered po to 12 healthy human volunteers at a dose of either 20 mL or 30 mL, and urinary excretions of cephaeline and emetine as well as blood and vomit concentrations were detected by HPLC. All participants showed vomiting after the 30 mL dose within 1 h, whereas 2/6 did not show vomiting within 4 h after the 20 mL dose. Percentage recovery of alkaloids in vomit were 39 +/- 38 or 76 +/- 14% after the 20 mL or 30 mL doses, respectively. In most participants, plasma alkaloids reached their maximum levels within I h and became undetectable after 6 h. Total excretions of ipecac alkaloids into the urine within the first 48 h were less than 2%, but both alkaloids were detectable in the urine at 2w in all participants and could be detected up to 12w in 1/2 participants who did not vomit. These results show that ipecac alkaloids may be detectable in urine several weeks after ingestion and suggest that their detection in urine may be helpful to identify the Munchausen syndrome by proxy using ipecac syrup.

Cellular localization of tumor necrosis factor-alpha mRNA and interleukin-6 mRNA in the rat liver after hemorrhagic shock.

PURPOSE: Our previous studies showed that tumor necrosis factor (TNF)-alpha and interleukin (IL)-6 are induced after hemorrhagic shock and that their induction is attenuated by hyperbaric oxygen treatment. In this study, we tried to identify the cell types in the liver that are responsible for the increase in TNF-alpha mRNA and IL-6 mRNA after hemorrhage using in situ reverse transcription-polymerase chain reaction (in situ RT-PCR). METHODS: Chronically cannulated rats were subjected to hemorrhage, maintaining a mean arterial blood pressure of 40 mmHg for 1 h. They were resuscitated with the collected blood and saline, and the livers were removed at designated times, then fixed and frozen. RESULTS: Standard in situ hybridization could not detect the mRNAs of TNF-alpha and IL-6 in the livers; however, in situ RT-PCR detected TNF-alpha mRNA and IL-6 mRNA mainly in the vascular endothelial cells and perivascular nonparenchymal cells of the bled rats. Sinusoidal cells were positive for TNF-alpha mRNA, but negative for IL-6 mRNA. No signal was found in normal rats, or when the experimental protocol was modified to: omit the RT step; precede the RT step with RNA digestion; or use an irrelevant probe. CONCLUSION: These results show that vascular endothelial cells and perivascular nonparenchymal cells are activated after massive hemorrhage to produce inflammatory cytokines.