Plant Poisoning, Hemlock : Diagnosis and Differentials
Clinical
History:
In cases of plant toxicity, history may be obscure and ingested plants may not be available for identification.
- Poison hemlock
- Nausea and vomiting
- Abdominal pain
- Tachycardia
- Tremor
- Seizures (much more common with water hemlock)
- Bradycardia (late)
- Ascending paralysis (late)
- Coma
- Respiratory failure
- Water hemlock
- Nausea and vomiting
- Abdominal pain
- Delirium
- Convulsions, opisthotonus, hemiballismus
- Seizure (status epilepticus)
Physical:
- Poison hemlock: Signs of poison hemlock toxicity can be divided into an early stimulation phase and, in severe poisonings, a later depressant phase.
- Emesis
- Salivation
- Mydriasis
- Tachycardia, then bradycardia
- Initial fasciculations, then flaccid paralysis
- Hypoventilation, respiratory arrest
- Water hemlock: Signs of water hemlock toxicity begin with GI symptoms, which are rapidly followed by CNS excitation.
- Emesis
- Mydriasis
- Agitation
- Delirium
- Convulsions
- Seizures
- Coma
Causes:
- Hemlock plants may be intentionally ingested. However, most ingestions are accidental.
- Poison hemlock may be mistaken for wild carrots.
- Water hemlock may be mistaken for wild parsnips orartichokes.
- Birds ingesting hemlock during migratory flight may be reported tocause coturnism (human poisoning after eating quail).
Differentials
Encephalitis
Hypoglycemia
Schizophrenia
Toxicity,
Cyclic Antidepressants
Toxicity, Hallucinogen
Toxicity,
Methamphetamine
Toxicity, Mushroom -
Gyromitra Toxin
Toxicity, Mushroom -
Hallucinogens
Toxicity, Mushrooms
Toxicity,
Phencyclidine
Other Problems to be Considered:
Botulism
Nicotine (wild tobacco)
Golden chain (Laburnum
anagyroides)
Strychnine
Cholinergic
poisoning
Psychosis
Encephalopathy
Workup
- Consider the following tests if patient is hemodynamically unstable or has altered mental status or seizures:
- Basic metabolic profile including electrolytes, glucose, BUN, and creatinine
- Arterial blood gas
- Comprehensive drug screen to evaluate for co-ingestions
- Creatine kinase or urine myoglobin to screen for rhabdomyolysis
- Consider a pregnancy test for women of childbearing age.
- Perform chest radiographs if aspiration is suspected.
Other Tests:
- Chemical screening test for alkaloids in plant material provides confirmation of toxicity due to poison or water hemlock. However, a plant specimen (or ingested material) is required, and these tests are not routinely available.
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Bibliography
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