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Plant Poisoning, Hemlock : Follow-Up

Author Information and Disclosures

Follow-Up

Further Inpatient Care:

  • Observe the patient closely for at least 6 hours after presentation to evaluate for symptoms and progression.
  • Monitor all patients showing evidence of toxicity for possible seizures, dysrhythmias, or respiratory failure in an ICU setting.
  • Counsel pregnant patients that teratogenic effects from poison hemlock exposure have been reported in livestock.

Transfer:

  • Consider transferring the patient to a facility with a toxicology service.

Deterrence/Prevention:

  • Educate patients about avoiding ingestions of hemlock and other unidentifiable or mistakenly identified plants.

Complications:

  • Death (secondary to respiratory failure or status epilepticus)
  • Seizures (status epilepticus)
  • Rhabdomyolysis (renal failure)
  • Coma
  • Aspiration pneumonitis
  • Permanent neurologic sequelae

Prognosis:

  • The prognosis is good if the patient presents early and receives appropriate decontamination and supportive care.

Patient Education:

Miscellaneous

Medical/Legal Pitfalls:

  • Failure to consider diagnosis with history of wild plant ingestion
  • Failure to monitor patient after diagnosis is made
  • Complications following use of ipecac
  • Failure to evaluate and/or treat rhabdomyolysis
  • Failure to terminate seizures
  • Failure to consider an intentional ingestion (eg, suicidal act)

Special Concerns:

  • Counsel pregnant patients after acute toxicity is treated.
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Bibliography

  1. Ellenhorn MJ: Poison hemlock (Conium Maculatum). In: Ellenhorn's Medical Toxicology. 2nd ed. Williams and Wilkins; 1997:1841, 1871.
  2. Furbee B, Wermuth M: Life-threatening plant poisoning. Crit Care Clin 1997 Oct; 13(4): 849-88[Medline].
  3. Goldfrank LR, Flomenbaum NE, Lewin NA, et al, eds: Goldfrank's Toxicologic Emergencies. 6th ed. Appleton & Lange; 1998: 2, 318, 338, 1246, 1252-3.
  4. Hopkins J: The glycoalkaloids: naturally of interest (but a hot potato?). Food Chem Toxicol 1995 Apr; 33(4): 323-8[Medline].
  5. Krenzelok EP, Jacobsen TD: Plant exposures ... a national profile of the most common plant genera. Vet Hum Toxicol 1997 Aug; 39(4): 248-9[Medline].
  6. Litovitz TL, Klein-Schwartz W, Caravati EM: 1998 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1999 Sep; 17(5): 435-87[Medline].
  7. Litovitz TL, Klein-Schwartz W, Dyer KS: 1997 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1998 Sep; 16(5): 443-97[Medline].
  8. Litovitz TL, Klein-Schwartz W, White S: 1999 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2000 Sep; 18(5): 517-74[Medline].
  9. Lopez TA, Cid MS, Bianchini ML: Biochemistry of hemlock (Conium maculatum L.) alkaloids and their acute and chronic toxicity in livestock. A review. Toxicon 1999 Jun; 37(6): 841-65[Medline].
  10. Olson KR: Hemlock. In: Poisoning and Drug Overdose. 3rd ed. Appleton & Lange; 1999:22, 25, 30, 265-74.
  11. Panter KE, James LF, Gardner DR: Lupines, poison-hemlock and Nicotiana spp: toxicity and teratogenicity in livestock. J Nat Toxins 1999 Feb; 8(1): 117-34[Medline].
  12. Reynolds T: Hemlock alkaloids from Socrates to poison aloes. Phytochemistry 2005; 66(12): 1399-1406[Medline].
  13. Uwai K, Ohashi K, Takaya Y: Exploring the structural basis of neurotoxicity in C(17)-polyacetylenes isolated from water hemlock. J Med Chem 2000 Nov 16; 43(23): 4508-15[Medline].
  14. Vetter J: Poison hemlock (Conium maculatum L.). Food Chem Toxicol 2004 Sep; 42(9): 1373-82[Medline].
  15. Watson WA, Litovitz TL, Klein-Schwartz W, et al: 2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2004 Sep; 22(5): 335-404[Medline].
  16. Watson WA, Litovitz TL, Rodgers GC, et al: 2002 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2003 Sep; 21(5): 353-421[Medline].
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Synonyms And Related Keywords

poison hemlock, Conium maculatum, C maculatum, water hemlock, Cicuta maculata, C maculata, plant ingestion, Queen Anne's lace, wild carrot, fool's parsley

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Author Information and Disclosures

Author: Daniel E Brooks, MD, Chief, Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh Medical Center; Assistant Professor, Medical Director, W Virginia Poison Center, University of W Virginia

Daniel E Brooks, MD, is a member of the following medical societies: American College of Emergency Physicians, and American College of Medical Toxicology

Editor Information

Editor(s): David A Peak, MD, Instructor, Staff Physician, Department of Emergency Services, Massachusetts General Hospital, Harvard Medical School; John T VanDeVoort, PharmD, Clinical Assistant Professor, College of Pharmacy, University of Minnesota; Michael Hodgman, MD, Assistant Clinical Professor of Medicine, Department of Emergency Medicine, Bassett Healthcare; John Halamka, MD, Chief Information Officer, CareGroup Healthcare System, Assistant Professor of Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Assistant Professor of Medicine, Harvard Medical School; and Asim Tarabar, MD, Assistant Clinical Professor of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

 
 
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