An emetic (from Greek εμετικόν [φάρμακον] , emetikón [phármakon] with the Latin ending, literally "the nauseating [drug]", plural emetics ), emetic or vomitivum (from Latin vomitus , "vomiting", plural vomitiva ) is a Substance that causes vomiting as a reflex or directly in the central nervous system . In small doses , emetics also serve as expectorants and, if necessary, off-label as an anorectic ( appetite suppressant ). Since the stomach contents are transported against the direction of normal peristalsis when vomiting , the term antiperistaltic (plural antiperistaltic ) is sometimes used.
Medicines with the opposite effect are called antiemetics .
The following emetics are common in today's medicine :
- Ipecac - syrup (also: ipecac syrup) solves the strong up to 30 minutes delayed emesis caused by irritation of the nerve fibers responsible parasympathetic out.
- Apomorphine , a drug relatedto morphine thatactson the dopamine receptors in thevomiting center of the brain, causing vomiting.
- Copper sulphate , a salt that irritates the lining of the stomach and causes severe vomiting within five minutes.
Mechanism of action
The emetic stimuli are essentially mediated via the receptors for dopamine (D2), histamine ( H 1 ), acetylcholine ( M ) and serotonin (5-HT 3 ). 5-HT 3 receptors are found on postsynaptic neurons of endocrine cells, on endocrine glands of the stomach, in the vagus nerve and in many parts of the central nervous system , especially in the area postrema . Most of the serotonin is formed in the enterochromaffin cells of the gastrointestinal tract . Serotonin also has an important function in the transmission of stimuli to the intramural plexus ( plexus myentericus and plexus submucosus ) of the intestine. For example, an expansion of the intestinal wall, the administration of cytotoxic substances (chemotherapy) or radiation therapy lead to the release of serotonin. This then acts as a neurotransmitter or local hormone . The vomiting center in the formatio reticularis is ultimately excited via afferent tracts of the vagus nerve .
Use with medical indication
Toxins and drugs that B. were accidentally administered or ingested suicidally, can be removed from the stomach of the patient by an emetic. This measure is quicker and less problematic than gastric lavage ( gastric emptying using a gastric tube ). However, it must not be used after the ingestion of tissue or corrosive fluids, as additional damage to the esophagus or oral cavity cannot be avoided. In such cases, a feeding tube is always preferred.
The administration of emetics is also one of the traditional methods of Ayurvedic medicine .
Deliberate induction of vomiting was more common in medieval medicine, as was other drainage techniques . In modern times, were especially in cases of suspected toxicity , inter alia the root of as an emetic pokeweed , Mitragynin alkaloids, from the group of indole alkaloids , the effective emetic Vomicin (naming), ipecac , tartar emetic ( potassium antimonyl tartrate ), ammonium carbonate , alum , copper sulphate , zinc vitriol and apomorphine from the group of aporphine alkaloids are used. However, vomiting was also believed to be effective for catarrh , “feverish excitement” and “madness”, as well as for suffocation from an object in the esophagus . In this case, emetic tartar was injected under the skin.
Although scientific psychiatry was increasingly critical of emetics in the 19th century, they were still widely used in practice.
Application to preserve evidence
If it is suspected that someone is carrying a swallowed narcotic drug in the stomach ( body packing ), law enforcement authorities have an interest in securing the drugs as evidence . The emptying of the stomach can be accelerated by means of an emetic (compared to natural excretion via the faeces - which can also be accelerated by means of laxatives). The legality of such a measure is controversial because of medical risks, legal and constitutional principles.
In Germany (roughly between 1990 and 2006) Bremen , Lower Saxony , Berlin , Hesse and Hamburg used emetics to secure evidence. In doing so, they are based on Code of Criminal Procedure, paragraph 1 of which reads as follows: A physical examination of the accused may be ordered to establish facts that are relevant to the proceedings. For this purpose, the taking of blood samples and other physical interventions carried out by a doctor for examination purposes according to the rules of medical art are permitted without the consent of the accused, provided that there is no risk of harm to his health.
33 Council of Europe states opposed [the use of emetics], including countries such as Albania, Ukraine and Turkey. In the United States, the Supreme Court ruled in 1952 that 'these methods are too close to torture'.
Deaths have repeatedly been reported in connection with the use of emetics. Emetics can have a particularly dangerous effect in Mallory-Weiss syndrome , severe gastric damage from carcinoma and other previous damage to the gastrointestinal tract. Regardless of previous illnesses, aspiration (inhalation of the food), irritation of the vagus nerve and bolus death are possible with each vomiting .
The Frankfurt Higher Regional Court ruled in 1996 that the “administration of emetics” “violated human dignity and general personal rights”.
After Achidi John's death, “[the Federal Constitutional Court ] made it clear that it had never approved the use of emetics. In 1999 the court found in one case that emetics 'are not subject to any fundamental constitutional concerns with regard to human dignity and freedom from self-incriminations'. But first, medical questions need to be clarified. And: That says nothing about 'the extent to which forced administration is permissible'. "
On June 11, 2006, the European Court of Human Rights (ECHR) ruled that the forcible administration of emetics through a gastric tube is not permitted in Europe (individual complaint no. 54810/00). Firstly, it violates the prohibition of inhuman and degrading treatment under European Convention on Human Rights (ECHR). If the knowledge gained in this way is used in criminal proceedings, it is secondly a violation of the human right not to accuse oneself ( Para. 1 ECHR, nemo tenetur principle ) and thus at the same time a violation of the right to a fair trial which can lead to a ban on the use of evidence . The opposite point of view, which was previously partly represented in Germany on Code of Criminal Procedure , in which the Federal Constitutional Court did not make a statement on the legal admissibility of the administration of emetics, but instead rejected the constitutional complaint for formal reasons, is therefore outdated.
It is unclear whether the forced use of emetics falls under the narrower concept of torture in the sense of the UN Convention against Torture . Against it speaks that it is not about extorting a confession and officially not about "punishment" either. On the other hand, the measure does serve as a deterrent .
The administration of an emetic as an investigative measure is controversial, regardless of the coercion used. Depending on the gravity of the allegation, this measure may violate the principle of proportionality . The ECHR sees elimination control as a milder means. This is not without controversy. Furthermore, the suspect is indirectly forced to incriminate himself if he is asked to take an emetic (even without compulsion). At least the emetic must be administered by a doctor, who must examine possible contraindications , such as impaired consciousness , intoxicated state, acute illnesses, illnesses in the gastrointestinal region and in the cardiovascular system.
Other problems are:
- medical interventions without the consent of the sane patient are bodily harm ; Interventions that are not medically necessary (the drug packages usually obtained from the stomach are small, hard-pressed cocaine pellets or crack stones that are only rarely leaked),
- the relative uselessness - rarely is the pure drug content of the seized material sufficient for a longer term imprisonment.
A conceivable alternative would be special "drug toilets", which can absorb the suspected narcotics after the natural gastrointestinal passage, as z. B. is already happening in the remand prison in Hamburg. Disadvantages here are the potentially long waiting time, which can collide with the maximum permissible time of police custody , and the risk of hiding again immediately after elimination.
Debate in Germany
The chairman of the SPD parliamentary group leader in the Hamburg parliament at the time , Holger Christier , said in February 2001 about the use of emetics to secure evidence: “This is an unpleasant story of police work, and I am convinced that it actually violates human dignity. The current state of affairs in Hamburg is: We do not need emetics. ”The later Hamburg Justice Senator Roger Kusch said that the introduction of emetics by Olaf Scholz two months before the state elections in September 2001 was a turnaround of 180 degrees; “It had a smell of dubiousness”. After the death of Achidi John as a result of using emetics in December 2001, the German Trade Union Confederation organized a discussion on the subject of emetics in early 2002. The then ver.di boss in Hamburg, Wolfgang Rose , rejected the method as disproportionate. The then President of the Hamburg Medical Association , Frank Ulrich Montgomery , spoke out against the method and in favor of laxatives . Olaf Scholz defended the method as there was no alternative . From the point of view of the then chairman of the police union , Konrad Freiberg , there would be no evidence without emetics and no convictions without evidence. Berlin and Lower Saxony stopped administering emetics after John's death. The Bremen citizenship also debated the case. The Greens asked to end the practice of emetics; the application was rejected. In Bremen, the practice was only ended in 2005 when Laya-Alama Condé died after using emetics. Hamburg ended the practice (as the last federal state) in 2006 after the judgment of the ECHR.
Abuse for eating disorders
In severe forms of bulimia , sick people also use emetics to quickly empty the stomach after an eating attack , similar to how anorexic people occasionally take laxatives to help them lose weight. Repeated use of both drug groups, especially when used improperly, results in electrolyte shifts (abnormal composition of blood salts ) and are therefore potentially life-threatening through possible provocations of epileptic seizures and cardiac arrhythmias . The frequent passage of gastric acid through the esophagus, mouth and nose damages the sensitive mucous membranes after only a few uses. Apart from the destruction of the sense of taste and smell, prolonged abuse can result in esophageal cancer. Emetics require a prescription.
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