Hemlock Poisoning Treatment & Management

Updated: Jun 06, 2017
  • Author: Daniel E Brooks, MD; Chief Editor: Michael A Miller, MD  more...
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Prehospital Care

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


Emergency Department Care

Rapidly assess and correct any life-threatening conditions. Since no antidote exists for either toxin, gastrointestinal (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. [6]

  • Secure airway.

  • Decontaminate the 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.



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.