A Los Angeles Coroner Signed A Death Certificate In February 1983

That Coroner Wrote Two Causes On One Line

One Was Anorexia Nervosa

The Other Was Heart Damage Caused By A Drug

The Drug Came From A Syrup Sold Without A Prescription

It Is No Longer Sold That Way

This Part Covers The Record And What Changed After It

THIS NEWSLETTER IS FOR INFORMATIONAL PURPOSES ONLY. NOTHING IN THIS CONTENT CONSTITUTES MEDICAL, PSYCHOLOGICAL, OR PROFESSIONAL ADVICE. ALWAYS CONSULT A QUALIFIED HEALTHCARE PROFESSIONAL BEFORE MAKING ANY HEALTH RELATED DECISIONS.

OKAY BACK FROM THE PHARMACY 🥄

Karen Carpenter Was A Popular American Singer Of The 1970s

She Died On 4 February 1983

Her Age Was 32

An Autopsy Was Performed In Los Angeles That Same Day

Ronald Kornblum Signed It As Acting Chief Medical Examiner

The Immediate Cause Was Emetine Cardiotoxicity

Due To Anorexia Nervosa Was Written Underneath It

Two Causes Were Written On One Line

Anorexia Nervosa Is The Only Disorder The Record Names

Emetine Is Not A Disease

It Is An Alkaloid Found In Ipecac Syrup

The Record Itself Does Not Mention Ipecac

Journalists Reported She Had Been Taking It To Avoid Weight Gain

A Toxicology Review Called It Ipecac Induced Cardiac Disease

The Summary Listed Pulmonary Edema And Cachexia And Dehydration

Her Heart Weighed 170 Grams

It Was Described As Small But Of Normal Shape

No Lesion Was Recorded In The Heart Muscle

The Document Was Technical And The Reaction Was Not

Eating Disorders Had Been Little Publicized Until Then

Ipecac Was A Standard Item In Medicine Cabinets

Its Purpose Was To Empty A Poisoned Stomach

Regulators Approved It For Over The Counter Sale In 1965

The Active Components Are Plant Alkaloids

Cephaeline Is One Of Them

Methyl Cephaeline Is The Other And It Is Emetine

Emetine Is The More Cardiotoxic Of The Two

It Makes Up More Than Half Of The Alkaloid Content

A Single Emergency Dose Was The Intended Use

Repeated Dosing Was Not The Intended Use

Misuse Can Lead To Cardiomyopathy

That Is Damage To The Heart Muscle Itself

One Published Case Involved An Adolescent Who Misused It

Proximal Muscle Weakness And Abdominal Pain Appeared

Cardiomyopathy Appeared In That Case As Well

Emetine Damage Is Related To Cumulative Exposure

A Toxic Dose Was Seen At Ten Times The Therapeutic One

The Product Was Doing Exactly What It Was Built To Do

Nothing About It Malfunctioned

The Danger Was In How Often It Was Used

The Death Was Not Only A Headline

Clinicians Who Treated Eating Disorders Responded To It

Two Years Later They Petitioned The Food And Drug Administration

Over The Counter Sale Of Ipecac Was What They Wanted Stopped

A Parent Could Buy It Without Speaking To Anyone

So Could Anyone Using It To Purge

That Petition Did Not Settle It

Pediatricians Still Backed A Bottle In Every Home In 1989

The Case That Ended It Was Built On Effectiveness

Studies Found It Less Effective Than Activated Charcoal

Its Use Often Delayed Better Decontamination

In 1997 Clinical Toxicologists Advised Against Routine Use

European Poison Centres Signed On To That Position

The Pediatrics Academy Dropped Its Advice In 2003

Syrup Of Ipecac Still Exists As A 7% Oral Syrup

It Is No Longer Available For Over The Counter Sale

Prescription Use Is Not Available Either

One Famous Death Was Not The Only Reason

The Disorder Behind The Dosing Did Not Get Reclassified

Only The Product Was Taken Off The Shelves