Resin Poisoning Clinical Presentation

  • Author: Hagop A Isnar, MD, FACEP; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Feb 1, 2011
 

History

Most plants involved in exposures reported to poison control centers are identified. However, plants often remain unidentified when patients come to the ED because of concern regarding plant ingestion or symptoms following plant ingestion or exposure.

Because toxic principles of plants may vary greatly by season and geography, systematic evaluation is invaluable for determining the etiology of the patient's symptoms and identifying the potential plant toxin. Generally, this is the case when describing circumstances surrounding the toxicity to the poison center or consulting toxicologist over the telephone.

Emergency physicians must obtain accurate history to determine extent of exposure and subsequent risk of disease. The following items may provide important information:

  • Name of plant (note that common names vary considerably by region)
  • Actual plant (if available, allows for detailed description of features)
  • Amount ingested or exposed
  • Duration of time since exposure
  • Initial symptoms and time between exposure and symptom onset
  • Past medical history, current medication, and allergies (These may alter host response and risk.)
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Physical

A thorough examination focusing on existence or development of toxidromes (eg, anticholinergic syndromes, nicotinic syndromes) may be helpful in identifying the general class of toxin(s). It is very important to repeat this evaluation over time (generally several hours) to follow the evolution of symptoms and response to treatment.

  • Many plants cause nonspecific gastrointestinal upset. Possible poison hemlock ingestion is suggested when gastrointestinal upset is accompanied by early onset of increased secretions followed by nicotinic syndromes such as respiratory difficulty, altered mental status, and possibly seizures (see image below). Hemlock. Photo by Cornell University Poisonous PlaHemlock. Photo by Cornell University Poisonous Plants Informational Database.
  • Plant ingestion alone is unlikely to cause isolated altered mental status.
  • Physicians must always consider other causes of acute altered mental status, such as hypoglycemia, co-ingestants, concomitant trauma, or infection.
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Contributor Information and Disclosures
Author

Hagop A Isnar, MD, FACEP  Department of Emergency Medicine, Crouse Hospital

Hagop A Isnar, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Charles McKay, MD  Chief, Toxicology Section, Department of Traumatology and Emergency Medicine, Hartford Hospital

Charles McKay, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, and American College of Medical Toxicology

Disclosure: Nothing to disclose.

Specialty Editor Board

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT  Associate Clinical Professor; Medical and Managing Director, South Texas Poison Center, Department of Surgery/Emergency Medicine and Toxicology, University of Texas Health Science Center at San Antonio

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Clinical Toxicologists, American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, Society for Academic Emergency Medicine, and Texas Medical Association

Disclosure: Nothing to disclose.

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.

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.

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, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

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  2. Watson WA, Litovitz TL, Rodgers GC. 2004 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2005;23(5):589-666. [Medline].

  3. Arena J. Plants That Poison. Emerg Med. Jun 15 1989;20-64.

  4. Braitberg G, et al. Toxic plant ingestions. In: Wilderness Medicine. 1995:862-89.

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  14. Lee NP, Arriola ER. Poison ivy, oak, and sumac dermatitis. West J Med. Nov-Dec 1999;171(5-6):354-5. [Medline].

  15. Litovitz TL, Klein-Schwartz W, Caravati EM, et al. 1998 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1999;17(5):435-87. [Medline].

  16. Litovitz TL, Smilkstein M, Felberg L, et al. 1996 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1997;15(5):447-500. [Medline].

  17. McGovern TW, LaWarre SR, Brunette C. Is it, or isn't it? Poison ivy look-a-likes. Am J Contact Dermat. Jun 2000;11(2):104-10. [Medline].

  18. McKenzie RA, ALIA. Plant poisoning? Which plant?!. Aust Vet J. Jun 1993;70(6):201-2. [Medline].

  19. Patterson SE, Williams JV, Marks JG Jr. Prevention of sodium lauryl sulfate irritant contact dermatitis by Pro- Q aerosol foam skin protectant. J Am Acad Dermatol. May 1999;40(5 Pt 1):783-5. [Medline].

  20. Rondeau ES, Everson GW, Savage W, Rondeau JH. Plant nurseries: a reliable resource for plant identification?. Vet Hum Toxicol. Dec 1992;34(6):544-6. [Medline].

  21. Tilton BR, Ryan ME, Edson LY, Martyak GG. Plant ingestions in children. Pa Med. May 1985;88(5):45-9. [Medline].

 
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Hemlock. Photo by Cornell University Poisonous Plants Informational Database.
Daphne. Photo by Cornell University Poisonous Plants Informational Database.
Poison ivy. Photo by Cornell University Poisonous Plants Informational Database.
Poison ivy. Photo from the Centers for Disease Control and Prevention.
Poison oak. Photo by Cornell University Poisonous Plants Informational Database.
Poison sumac. Photo by Cornell University Poisonous Plants Informational Database.
Poison ivy rash. This photograph shows an individual's arm with a blistering poison ivy rash. Hardin Library for the Health Sciences, University of Iowa Public Domain Picture (http://www.lib.uiowa.edu/haRDIN/MD/cdc/4483.html) and Centers for Disease Control and Prevention.
Poison oak rash. This photograph depicts an individual's arm with a blistering poison oak rash. Note the linear pattern to the lesions. Hardin Library for the Health Sciences, University of Iowa Public Domain Picture (http://www.lib.uiowa.edu/haRDIN/MD/cdc/4484.html) and Centers for Disease Control and Prevention.
 
 
 
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