Ipecac, the plant that killed Karen Carpenter, the star consumed by anorexia

A recently published biography of 1970s pop star Karen Carpenter reveals that the announcement of her death from heart failure concealed death from slow poisoning caused by her addiction to ipecac root, an ancient indigenous medicine that has been banned since the end of clinical practice. 20th century.

Ipecac, an old familiar of tropical herbal medicine

A Written History of Ipecacuanha (Carapichea ipecacuanha)“road plant that makes you feel sick” in the Tupi language dates back to when it reached Europe thanks to Willem Piso, whose Historia Naturalis Brasiliae (1648) it was first mentioned as a febrifuge and emetic used by the natives of the Amazon. Doctor Helvetius used it to treat dysentery suffered by relatives of Louis XIV. The plant then disappeared from pharmacopoeial history until it reappeared in the 18th century in the basic formula for the famous Dover Powder, a remedy based on ground ipecac root, opium, and potassium sulfate, which, like modern day aspirin, was plentiful. known for 200 years for the treatment of all types of febrile processes.

Amoebic dysentery

As for dysentery, the terrible effects of which killed thousands of people who died of vomiting and bloody diarrhea, one of the first events to eradicate it occurred in 1875, when Fedor Losch discovered the amoeba (known today as Entamoeba histolytica) in the feces of a patient suffering from that disease.

In 1961, after overcoming seemingly insurmountable research difficulties, Louis Klein Diamond succeeded in growing amoeba in vitro. In the same decade in which E. histolytica two bacterial genera were found, Salmonella and: Shigella, has been found to cause other forms of dysentery. It was soon proven that ipecac root had no effect on these bacteria, making it an effective diagnostic tool for food poisoning.

Emetine hydrochloride

In the early 19th century, the Paris School of Chemistry discovered that ipecac root contained two powerful alkaloids, cephaleline and emetine (methylcephealine), which caused persistent vomiting and diarrhea. Emetine is obtained by direct extraction from ipecac root or by methylation of cephalin in laboratory conditions.

Emetine has many pharmacological possibilities. In eukaryotic cells, it inhibits protein synthesis by preventing the binding of peptide chains. In mammals, it blocks mitochondrial oxidative phosphorylation, interrupting cellular respiration and causing important changes in the heart and nervous system.

Hospital practice has proven extremely effective in eradicating amoebic dysentery, but it has presented considerable practical difficulties. From the beginning, the patient had to remain in a state of complete rest during the treatment. Moreover, it had to be administered by injection and the dosage needed to be precisely adjusted. On the other hand, it was necessary to closely monitor the gastrointestinal tract (vomiting and diarrhea), the nervous system (polyneuritis) and, above all, the potentially fatal cardiovascular changes, including hypotension and tachycardia.

If any of them appeared, the treatment should be stopped immediately, because, despite strict precautions, cases of sudden death were not uncommon.

Beginning in the 1950s, alternative treatments were sought that were effective orally and free of potentially fatal cardiac effects. Finally, success was achieved with diloxanide for intestinal amoebiasis and metronidazole for the hepatic form.

Ipecac and vomiting

Ipecac powder is an effective and safe emetic agent (90% success after 20 minutes), which is why it was very useful as a gastric lavage in cases of poisoning. Only occasionally does it cause serious complications, such as esophageal or gastric rupture, pneumomediastinum, pneumonia, and aspiration pneumonia.

On the one hand, the dust directly irritates the stomach and upper intestines, and on the other hand, when absorbed into the blood, indirectly affects chemoreceptors in the medulla oblongata, which controls vomiting in mammals.

In the 1990s, there was a broad consensus to abandon its emetic use in favor of activated charcoal injection. After its hospital use was suppressed, it continued to be used uncontrolled as a drug by patients with anorexia nervosa and bulimia nervosa, whose abuse produced a clinical syndrome that included myopathy, neuropathy, seizures, and sudden death.

Karen weighed 40 kilograms

In 1975, at the height of her career, Karen weighed 40 kg (88 lb). For years she struggled with anorexia nervosa, a disease about which almost nothing is known and whose exact cause is still unknown. In 1982, when he weighed only 34 kilograms (75 lb) and his digestive system was so damaged that he could only be fed intravenously, he underwent psychological treatment.

He admitted that he could simultaneously take more than 90 laxatives based on ipecac and 10 pills a day of a drug based on levothyroxine, a synthetic form of tyrosine, a thyroid hormone that speeds up metabolism. In 1983, his mother found him passed out in his room. He made it to the hospital alive, but his heart failed. The autopsy revealed everything. his body contained large doses of ipecac, which he had used as an emetic.

Forty years have passed since his death. At least it’s comforting to know that her voice remains the perfect gift to remember the unfortunate young woman, who would have turned 73 in 2023.

Manuel Peinado Lorca is a university professor and director of the Royal Botanical Gardens of the University of Alcalá.

This article was originally published The conversation.

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