eMedicine Specialties > Emergency Medicine > Toxicology

Plant Poisoning, Hemlock: Follow-up

Author: Daniel E Brooks, MD, Attending Physician, Department of Medical Toxicology, Co-Medical Director, Banner Poison Center, Banner Good Samaritan Medical Center
Contributor Information and Disclosures

Updated: Nov 7, 2008

Follow-up

Further Inpatient Care

  • Observe the patient closely for at least 6 hours after presentation to evaluate for symptoms and progression.
  • Monitor all patients showing evidence of toxicity for possible seizures, dysrhythmias, or respiratory failure in an ICU setting.
  • Counsel pregnant patients that teratogenic effects from poison hemlock exposure have been reported in livestock.

Transfer

  • Consider transferring the patient to a facility with a toxicology service.

Deterrence/Prevention

  • Educate patients about avoiding ingestions of hemlock and other unidentifiable or mistakenly identified plants.

Complications

Complications of hemlock ingestion may include the following:

  • Death (secondary to respiratory failure or status epilepticus)
  • Seizures (status epilepticus)
  • Rhabdomyolysis (renal failure)
  • Coma
  • Aspiration pneumonitis
  • Permanent neurologic sequelae

Prognosis

  • The prognosis is good if the patient presents early and receives appropriate decontamination and supportive care.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider diagnosis with history of wild plant ingestion
  • Failure to monitor patient after diagnosis is made
  • Complications following use of ipecac
  • Failure to evaluate and/or treat rhabdomyolysis
  • Failure to terminate seizures
  • Failure to consider an intentional ingestion (eg, suicidal act)

Special Concerns

  • Counsel pregnant patients after acute toxicity is treated.
 


More on Plant Poisoning, Hemlock

Overview: Plant Poisoning, Hemlock
Differential Diagnoses & Workup: Plant Poisoning, Hemlock
Treatment & Medication: Plant Poisoning, Hemlock
Follow-up: Plant Poisoning, Hemlock
Multimedia: Plant Poisoning, Hemlock
References
[ CLOSE WINDOW ]

References

  1. Uwai K, Ohashi K, Takaya Y. Exploring the structural basis of neurotoxicity in C(17)-polyacetylenes isolated from water hemlock. J Med Chem. Nov 16 2000;43(23):4508-15. [Medline].

  2. Watson WA, Litovitz TL, Klein-Schwartz W, et al. 2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2004;22(5):335-404. [Medline].

  3. Ellenhorn MJ. Poison hemlock (Conium Maculatum). In: Ellenhorn's Medical Toxicology. 2nd ed. Williams and Wilkins; 1997:1841, 1871.

  4. Furbee B, Wermuth M. Life-threatening plant poisoning. Crit Care Clin. Oct 1997;13(4):849-88. [Medline].

  5. Goldfrank LR, Flomenbaum NE, Lewin NA, et al, eds. Goldfrank's Toxicologic Emergencies. 6th ed. Appleton & Lange; 1998:2, 318, 338, 1246, 1252-3.

  6. Hopkins J. The glycoalkaloids: naturally of interest (but a hot potato?). Food Chem Toxicol. Apr 1995;33(4):323-8. [Medline].

  7. Krenzelok EP, Jacobsen TD. Plant exposures ... a national profile of the most common plant genera. Vet Hum Toxicol. Aug 1997;39(4):248-9. [Medline].

  8. Litovitz TL, Klein-Schwartz W, Caravati EM. 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].

  9. Litovitz TL, Klein-Schwartz W, Dyer KS. 1997 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1998;16(5):443-97. [Medline].

  10. Litovitz TL, Klein-Schwartz W, White S. 1999 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2000;18(5):517-74. [Medline].

  11. Lopez TA, Cid MS, Bianchini ML. Biochemistry of hemlock (Conium maculatum L.) alkaloids and their acute and chronic toxicity in livestock. A review. Toxicon. Jun 1999;37(6):841-65. [Medline].

  12. Olson KR. Hemlock. In: Poisoning and Drug Overdose. 3rd ed. Appleton & Lange; 1999:22, 25, 30, 265-74.

  13. Panter KE, James LF, Gardner DR. Lupines, poison-hemlock and Nicotiana spp: toxicity and teratogenicity in livestock. J Nat Toxins. Feb 1999;8(1):117-34. [Medline].

  14. Reynolds T. Hemlock alkaloids from Socrates to poison aloes. Phytochemistry. 2005;66(12):1399-1406. [Medline].

  15. Vetter J. Poison hemlock (Conium maculatum L.). Food Chem Toxicol. Sep 2004;42(9):1373-82. [Medline].

  16. Watson WA, Litovitz TL, Rodgers GC, et al. 2002 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2003;21(5):353-421. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

hemlock, plant poison hemlock, poison hemlock, Conium maculatum, C maculatum, water hemlock, Cicuta maculata, C maculata, plant ingestion, Queen Anne's lace, wild carrot, fool's parsley

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Daniel E Brooks, MD, Attending Physician, Department of Medical Toxicology, Co-Medical Director, Banner Poison Center, Banner Good Samaritan Medical Center
Daniel E Brooks, MD is a member of the following medical societies: American College of Emergency Physicians and American College of Medical Toxicology
Disclosure: Nothing to disclose.

Medical Editor

David A Peak, MD, Assistant Residency Director of Harvard Affiliated Emergency Medicine Residency, Attending Physician, Massachusetts General Hospital; Consulting Staff, Department of Hyperbaric Medicine, Massachusetts Eye and Ear Infirmary
David A Peak, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society
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, 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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.