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Plant Poisoning, Alkaloids - Quinolizidine and Isoquinoline: Differential Diagnoses & Workup

Author: David Vearrier, MD, Fellow, Department of Toxicology, Drexel University College of Medicine
Coauthor(s): Richard J Hamilton, MD, FAAEM, FACMT, Chairman, Department of Emergency Medicine, Drexel University College of Medicine
Contributor Information and Disclosures

Updated: Apr 13, 2009

Differential Diagnoses

Delirium, Dementia, and Amnesia
Toxicity, Caffeine
Hypoglycemia
Toxicity, Clonidine
Meningitis
Toxicity, Cocaine
Plant Poisoning, Alkaloids - Tropane
Toxicity, Hallucinogen
Plant Poisoning, Glycosides - Cardiac
Toxicity, Mushroom - Hallucinogens
Plant Poisoning, Herbs
Toxicity, Narcotics
Status Epilepticus
Toxicity, Theophylline
Toxicity, Amphetamine
Withdrawal Syndromes
Toxicity, Anticholinergic
Toxicity, Antidepressant
Toxicity, Antidysrhythmic

Workup

Laboratory Studies

  • Assays for isoquinoline or quinolizidine alkaloids are not routinely available.
  • A toxicology screen may be helpful in excluding amphetamine ingestion, but false-positive results may occur.
  • Blood chemistries may be useful in assessing for other potential intoxicating ingestions.
  • Perform a fingerstick glucose test for altered mental status.
  • Perform a complete blood count (CBC), urinalysis, and blood and urine cultures in febrile patients with altered mental status.
  • Always consider acetaminophen and salicylate levels in any potential toxic ingestion.
  • Always obtain serum or urine human chorionic gonadotropin (HCG) levels in women of childbearing age.
  • Draw a baseline liver function panel and CBC if ingestion of C majus (greater celandine) is suspected.

Imaging Studies

  • Consider a CT scan of the head in any patient whose altered mental status is not clearly due to toxicity of the ingested substance.

Other Tests

  • Obtain an ECG in all patients with possible toxic ingestions to evaluate for tricyclic antidepressant toxicity.

Procedures

  • Perform lumbar puncture on any febrile patient with altered mental status if meningitis is considered as a potential diagnosis.

More on Plant Poisoning, Alkaloids - Quinolizidine and Isoquinoline

Overview: Plant Poisoning, Alkaloids - Quinolizidine and Isoquinoline
Differential Diagnoses & Workup: Plant Poisoning, Alkaloids - Quinolizidine and Isoquinoline
Treatment & Medication: Plant Poisoning, Alkaloids - Quinolizidine and Isoquinoline
Follow-up: Plant Poisoning, Alkaloids - Quinolizidine and Isoquinoline
References
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References

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Further Reading

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Keywords

plant poisoning, plant toxicity, alkaloids, quinolizidine, isoquinoline, Baptisia species, false indigo, Cytisus species, scotch broom, Laburnum species, goldenchain, laburnum, Lupinus species, lupine, bluebonnet, Sophora species, mescal bean, frijolito, Argemone species, prickly poppy, Chelidonium species, celandine poppy, Corydalis species, fitweed, Dicentra species, dutchman's breeches, Papaver species, poppy, Sanguinaria species, bloodroot

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Contributor Information and Disclosures

Author

David Vearrier, MD, Fellow, Department of Toxicology, Drexel University College of Medicine
David Vearrier, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and American College of Occupational and Environmental Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Richard J Hamilton, MD, FAAEM, FACMT, Chairman, Department of Emergency Medicine, Drexel University College of Medicine
Richard J Hamilton, MD, FAAEM, FACMT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Michael S Beeson, MD, MBA, FACEP, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine; Program Director, Emergency Medicine Residency, Summa Health System
Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals
John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

Michael Hodgman, MD, Assistant Clinical Professor of Medicine, Department of Emergency Medicine, Bassett Healthcare
Michael Hodgman, MD is a member of the following medical societies: American College of Medical Toxicology, American College of Physicians, Medical Society of the State of New York, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD, Assistant Professor, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
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