eMedicine Specialties > Emergency Medicine > Toxicology

Plant Poisoning, Alkaloids - Quinolizidine and Isoquinoline: Follow-up

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

Follow-up

Further Inpatient Care

  • Patients with no signs of neurologic or cardiovascular involvement may be discharged from the hospital after 6 hours of observation.
  • Admit any patient with altered mental status, seizure activity, or cardiovascular instability to an intensive care unit (ICU) setting for observation and further treatment as needed.
  • Draw a baseline liver function panel and CBC if ingestion of C majus (greater celandine) is suspected, and refer the patient for follow-up repeat liver function test and CBC.

Further Outpatient Care

  • Ensure close follow-up care with a pediatrician or internist and instruct a responsible individual to return the patient to the emergency department immediately if altered mental status, seizure, vomiting, or any other concerns arise.
  • Caution against further ingestion of herbal medications. Family members of intoxicated children should be instructed to remove offending plants from their landscaping.

Complications

  • Most patients with quinolizidine and/or isoquinoline plant ingestions do well and are discharged from the emergency department after a period of observation.
  • Patients with systemic symptoms require admission and close observation to prevent morbidity or mortality.
  • Rarely, seizure, cardiovascular collapse, and aspiration secondary to emesis may complicate care.
  • Celandine has been reported to have significant hepatotoxicity.

Prognosis

  • Most patients recover fully and are discharged from the emergency department.

Patient Education

  • Educate families regarding common household plant toxicity. Tailor education to individual ingestions.

Miscellaneous

Medicolegal Pitfalls

  • As with any ingestion, consider co-ingestions, especially those that are potentially serious and treatable (eg, tricyclics, acetaminophen).
  • Consider all possible causes for altered mental status, including infectious diseases such as meningitis and encephalitis.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, William G Davenport, Jr, MD, to the development and writing of this article.



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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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