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Hemlock Poisoning Treatment & Management

  • Author: Daniel E Brooks, MD; Chief Editor: Asim Tarabar, MD  more...
 
Updated: Apr 21, 2015
 

Prehospital Care

For patients with possible hemlock poisoning, maintain the airway, obtain IV access airway, and assist with ventilation as needed.

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Emergency Department Care

Rapidly assess and correct any life-threatening conditions. Since no antidote exists for either toxin, GI decontamination (if appropriate) and aggressive supportive care are mainstays of treatment for hemlock poisoning. Schep et al provide a concise review of water hemlock poisoning and management.[2]

  • Secure airway.
  • Decontaminate GI tract if timing is appropriate.
    • If no contraindications exist, gastric lavage may be of limited benefit if performed rapidly after the ingestion.
    • Administer activated charcoal if the patient is able to protect the airway and presents within 1 hour of ingestion. Ipecac should not be used.
    • Caution should be exercised in patients exposed to water hemlock because they are at increased risk of having seizures, and can eventually aspirate the charcoal.
  • Treat seizures with benzodiazepines; use barbiturates if needed.
    • Provide prophylaxis with water hemlock ingestion.
    • Benzodiazepines and barbiturates help control agitation and raise the seizure threshold.
  • Aggressively administer IV fluids for dehydration or rhabdomyolysis.
    • Replete volume if signs of hypovolemia or hypotension are present.
    • Correct electrolyte abnormalities.
    • Administer fluids with sodium bicarbonate for urinary alkalinization if evidence of rhabdomyolysis exists. If using sodium bicarbonate, mixing it in 5% dextrose in water (D5W) is important to limit the amount of sodium load.
  • Potassium levels should be monitored and corrected as needed.
  • Administer antiemetics. Many antiemetics may lower the seizure threshold and should be used cautiously.
  • Provide ventilatory support, if necessary.
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Consultations

A regional poison center or a medical toxicologist can assist with patient treatment and potentially with plant identification. The regional poison control center should be contacted (800-222-1222) to discuss optimal management of all known or suspected hemlock poisonings.

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Contributor Information and Disclosures
Author

Daniel E Brooks, MD Co-Medical Director, Banner Good Samaritan Poison and Drug Information Center, Department of Medical Toxicology, Banner Good Samaritan Medical Center

Daniel E Brooks, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology

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

David A Peak, MD Associate Residency Director of Harvard Affiliated Emergency Medicine Residency; Attending Physician, Massachusetts General Hospital; Assistant Professor, Harvard Medical School

David A Peak, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, American Medical Association

Disclosure: Partner received salary from Pfizer for employment.

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.

References
  1. Mowry JB, Spyker DA, Cantilena LR Jr, McMillan N, Ford M. 2013 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 31st Annual Report. Clin Toxicol (Phila). 2014 Dec. 52(10):1032-283. [Medline]. [Full Text].

  2. Schep LJ, Slaughter RJ, Becket G, Beasley DM. Poisoning due to water hemlock. Clin Toxicol (Phila). 2009 Apr. 47(4):270-8. [Medline].

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

  4. Furbee B, Wermuth M. Life-threatening plant poisoning. Crit Care Clin. 1997 Oct. 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. 1995 Apr. 33(4):323-8. [Medline].

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

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

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

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

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

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

  13. 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. 2003 Sep. 21(5):353-421. [Medline].

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Hemlock. Photo by Cornell University Poisonous Plants Informational Database
 
 
 
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