eMedicine Specialties > Emergency Medicine > Toxicology

Plant Poisoning, Resins: Follow-up

Author: Hagop A Isnar, MD, FACEP, Associate Medical Director, Consulting Staff, Department of Emergency Medicine, Auburn Memorial Hospital
Coauthor(s): Charles McKay, MD, Chief, Toxicology Section, Department of Traumatology and Emergency Medicine, Hartford Hospital
Contributor Information and Disclosures

Updated: Mar 2, 2009

Follow-up

Further Inpatient Care

  • Water hemlock
    • Symptoms of cicutoxin should manifest within 2 hours of observation in the ED.
    • In a symptomatic patient, close monitoring of respiratory status is essential.
    • Care is mostly supportive with particular attention to fluid balance (because of GI loss); benzodiazepines are used for possible seizures.

Further Outpatient Care

  • Toxicodendron
    • With most cases involving outpatient treatment, complete resolution of symptoms should occur within 3 weeks of therapy.
    • Complications include infection and hyperpigmentation of the involved area.
    • Weekly follow-up visits are recommended to document the progress of treatment.

Deterrence/Prevention

  • Currently, pharmaceutical companies and the United States military actively research protective agents to prevent contact dermatitis from resin skin exposure.
  • Currently, Hylands produces an over-the-counter barrier product called Ivyblock, which is reported to prevent dermatitis pre-exposure.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider, exclude, and treat other causes of acute altered mental status such as occult trauma or infection
  • Failure to appreciate the potentially severe gastrointestinal and other toxicities that may result from exposure to plants such as chinaberry and nicotinic plant species
  • Incorrectly identifying plants leading to inadequate observation, evaluation, and treatment
    • In 1998, 19% of calls to American poison control centers regarding plant exposures were coded as "unknown plant."
    • Plant identification over the telephone may be difficult.
    • Identification of plant parts by individuals at plant nurseries and gardening stores is accurate in fewer than 50% of cases, and botanists are unable to identify approximately 25%, often secondary to inadequate sample.
    • Relying on pictures in an atlas is just as problematic.
    • While software programs exist that will guide the user through a systematic plant identification scheme leading to accurate classification in most cases, these programs are not widely available and are somewhat cumbersome for use in an emergency setting.
    • In some cases, a cautious tentative identification can be made in consultation with poison control centers with special interest in botanical exposures. This is particularly worthwhile in cases with potentially delayed toxicity or lack of correlation of observed symptoms with the presumed identity of the plant.
  • Failure to recognize significant toxicity related to toxic plants that are indigenous to the patient's geographic location
 


More on Plant Poisoning, Resins

Overview: Plant Poisoning, Resins
Differential Diagnoses & Workup: Plant Poisoning, Resins
Treatment & Medication: Plant Poisoning, Resins
Follow-up: Plant Poisoning, Resins
Multimedia: Plant Poisoning, Resins
References
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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].

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  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].

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Further Reading

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Keywords

plant poisoning resins, resins, plant resins, poison ivy, poison oak, poison sumac, contact dermatitis, glycoresins, oleoresins, urushiols, poisonous plants, poisonous plant exposures, plant toxin, Toxicodendron species, Cicuta maculata, water hemlock, cicutoxin, chinaberry, Melia azedarach, tetranortriterpene, daphne, daphnetoxin, toxic plant ingestion, resin skin exposure

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Contributor Information and Disclosures

Author

Hagop A Isnar, MD, FACEP, Associate Medical Director, Consulting Staff, Department of Emergency Medicine, Auburn Memorial 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.

Medical Editor

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