Approach Considerations
Assays for isoquinoline or quinolizidine alkaloids are not routinely available. Instead, the workup is devoted principally to excluding other possible causes of the patient’s symptoms. Consulting a medical toxicologist or poison control center may prove helpful in developing differential diagnoses and identifying toxic ingestion.
In patients with celandine exposure, liver function tests may demonstrate markedly elevated serum aminotransferases and direct and total bilirubin. Urinalysis may demonstrate bilirubinuria. If performed, liver biopsy may demonstrate hepatocellular injury with periportal and intralobular necrosis. Septal fibrosis has also been reported. [10]
A toxicology screen may be helpful in excluding amphetamine ingestion, but false-positive results may occur. Blood chemistries may be useful in assessing for other potential intoxicating ingestions. Perform a fingerstick glucose test for altered mental status, to rule out hypoglycemia. Perform a complete blood count (CBC), urinalysis, and blood and urine cultures in febrile patients with altered mental status. Perform lumbar puncture on any febrile patient with altered mental status if meningitis is considered as a potential diagnosis.
Always consider acetaminophen and salicylate levels in any potential toxic ingestion. Always obtain serum or urine human chorionic gonadotropin (HCG) levels in women of childbearing age.
Obtain an electrocardiogram in all patients with possible toxic ingestions to evaluate for sodium or potassium channel blockade resulting in prolonged QRS complex or QT intervals. Consider a computed tomography scan of the head in any patient whose altered mental status is not clearly due to toxicity of the ingested substance.
