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Hypoglycemic Plant Poisoning Treatment & Management

  • Author: Nathan Reisman, MD; Chief Editor: Asim Tarabar, MD  more...
 
Updated: Apr 28, 2015
 

Prehospital Care

Prehospital providers are unlikely to be familiar with or recognize hypoglycemic plant poisoning, but can usually treat both seizures and hypoglycemia in the prehospital setting.

Both seizures and hypoglycemia, as well as airway compromise, should be treated according to local protocols.

Intravenous or intraosseous access should be obtained and administration of dextrose, benzodiazepines (if needed to control seizures), and dextrose-containing intravenous fluid, as necessary, should be provided.

Intranasal benzodiazepines may be useful in the actively seizing patient in whom intravenous or intraosseous access is difficult or unsuccessful.[7, 8]

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Emergency Department Care

ED management of ackee poisoning is mainly supportive.

Obtain a rapid fingerstick glucose and initiate early glucose replacement with D50W boluses (D25W boluses in young children and D10W in neonates) and continuous infusions of 10% dextrose, as needed.

Airway assessment and endotracheal intubation, if necessary, should be performed.

Activated charcoal may be administered once the airway is secured.

Electrolyte status should be assessed.

Antiemetics such as metoclopramide, ondansetron, or granisetron may be administered for profuse vomiting.

Seizure precautions should be followed; treat seizures with benzodiazepines and dextrose.

Theoretically, L-carnitine could be beneficial similar to its effect in valproic acid toxicity.

Methylene blue has a theoretical benefit in ackee fruit poisoning, but animal studies do not show any benefit over early glucose administration alone.[9] There are no data in humans.

There are no data on the use of glucagon or octreotide in the treatment of hypoglycemia associated with hypoglycemic plant poisoning.

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Consultations

The local poison center should be contacted.

Consultation with a toxicologist may be helpful.

Contact public health authorities for suspected outbreaks.

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Contributor Information and Disclosures
Author

Nathan Reisman, MD Clinical Assistant Instructor, Department of Emergency Medicine, Kings County Hospital Center, SUNY Downstate Medical Center

Nathan Reisman, MD is a member of the following medical societies: Emergency Medicine Residents' Association, Society for Simulation in Healthcare

Disclosure: Nothing to disclose.

Coauthor(s)

Sage W Wiener, MD Assistant Professor, Department of Emergency Medicine, State University of New York Downstate Medical Center; Director of Medical Toxicology, Department of Emergency Medicine, Kings County Hospital Center

Sage W Wiener, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and 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.

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.

Additional Contributors

B Zane Horowitz, MD, FACMT Professor, Department of Emergency Medicine, Oregon Health and Sciences University School of Medicine; Medical Director, Oregon Poison Center; Medical Director, Alaska Poison Control System

B Zane Horowitz, MD, FACMT is a member of the following medical societies: American College of Medical Toxicology

Disclosure: Nothing to disclose.

Acknowledgements

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.

Jennifer Coles Schecter, MD Resident Physician, Department of Emergency Medicine, Lahey Clinic, Burlington, MA

Disclosure: Nothing to disclose.

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