Tartar Emetic Case

Case

Ingestion of tartar emetic (antimony potassium tartrate)

• 24 yr M who presented to emergency department with abdominal pain and vomiting
• Four hours prior he ingested two bottles of a product containing tartar emetic called “Soluto Vital Tartaro Emetico” to help with alcohol cessation
• Tachycardic (109 beats/minute) and normotensive with non-bloody emesis and abdominal pain, but otherwise normal vital signs and physical examination.
• EKG demonstrated a QRS duration of 100 msec and QTc 439 msec
• Received normal saline 1 L intravenously, thiamine 100 mg intravenously, and multiple-dose activated charcoal 80 g orally (after his vomiting was controlled with ondansetron 4 mg intravenously).
• The patient was asymptomatic after a few hours.
• Patient ended up leaving AMA and remained asymptomatic for 19 days, but then was lost to follow up
• Blood antimony concentration taken in the emergency department was 87 mg/L (normal <3 mg/L). A repeat concentration obtained 6 d later at an outpatient appointment was 7 mg/L.

By Alicia Everton, Lindsey Smith, Grant Houselog & Joshua Trebach

Background

• Tartar emetic, antimony potassium tartrate, is a product that induces emesis to treat alcohol use disorder.
• No evidence that tartar emetic treats alcohol use disorder, however, widely available to treat
• Antimonial cups were used back in 17th and 18th century in Europe and wine that was kept in cup for a 24 hour period gained emetic quality
• In 1941, Mrs. Moffat's Shoo-Fly Powders for Drunkenness was popular “antidote” for drunkenness.
• The powder was made of tartar emetic and ultimately ruled to be ineffective

Other Cases

• Most reported cases of tartar emetic poisoning involved chelation.
• In one case, a 34-year old man who ingested tartar emetic received dimercaprol, was followed for 1 month after hospitalization, at which time he appeared well and had normal laboratory tests.
• In a case series of four patients who ingested tartar emetic and were treated with dimercaprol, three out of four survived without sequelae

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