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Girl declared brain-dead after eating hemlock - Parents Donating Organs
The Dallas Morning News ^ | March 13, 2002 | By HOLLY WARREN / The Dallas Morning News

Posted on 03/13/2002 4:53:54 AM PST by MeekOneGOP

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To: MeeknMing; Li'lFreeper
They were talking about total plant poisonings, not number of hemlock poisonings.

eMedicine - Plant Poisoning, Hemlock : Article by Daniel E Brooks, MD
eMedicine World Medical Library
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Plant Poisoning, Hemlock


Synonyms, Key Words, and Related Terms: poison hemlock (Conium maculatum), water hemlock (Cicuta maculata)
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 eMedicine Journal > Emergency Medicine > Toxicology > Plant Poisoning, Hemlock
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AUTHOR INFORMATION Section 1 of 10    Click here to go to the top of this page Click here to go to the next section in this topic

Authored by Daniel E Brooks, MD, Fellow, Department of Medical Toxicology, Good Samaritan Regional Medical Center

Daniel E Brooks, MD, is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Edited by David A Peak, MD, Instructor, Staff Physician, Department of Emergency Services, Massachusetts General Hospital, Harvard Medical School; John T VanDeVoort, PharmD, DABAT, Manager, Clinical Assistant Professor, Pharmacy Department, Regions Hospital; Michael Hodgman, MD, Assistant Clinical Professor of Medicine, Department of Emergency Medicine, Bassett Healthcare; John Halamka, MD, Chief Information Officer, CareGroup Healthcare System, Assistant Professor of Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Assistant Professor of Medicine, Harvard Medical School; and Raymond J Roberge, MD, MPH, FAAEM, FACMT, Research Director, Department of Emergency Medicine, Ohio Valley Medical Center; Clinical Associate Professor, Department of Emergency Medicine, University of Pittsburgh

Author's Email: Daniel E Brooks, MD Click here to view conflict-of-interest information on the author of this topic
Editor's Email: David A Peak, MD

eMedicine Journal, May 11 2001, Volume 2, Number 5

INTRODUCTION Section 2 of 10   Click here to go to the previous section in this topic Click here to go to the top of this page Click here to go to the next section in this topic

Background: Toxic plant exposure is the fourth most common cause of nationwide poisoning, accounting for more than 100,000 annual reports to poison control centers. Pediatric patients comprise more than 80% of plant related exposures. Only 5-20% of plant exposures require medical management; only a few plants, poison hemlock and water hemlock included, are associated with life-threatening toxicity.

Hemlock poisoning may refer to poisoning by either poison hemlock (Conium maculatum) or water hemlock (Cicuta maculata). Historically, poison hemlock was reportedly used to execute Socrates and the Old Testament describes rhabdomyolysis in Israelites who consumed quail fed on hemlock.

Although related, poison hemlock and water hemlock toxicity have different pathophysiology and clinical presentations. The root contains the greatest concentration of toxin in both species, although all plant parts are toxic. Poison hemlock causes "crooked calf disease," a congenital abnormality, among cattle formed via fetal exposure. No antidote is available for either toxin.

Poison hemlock, an exotic species introduced to the US, is a ubiquitous plant with fernlike properties that may reach a height of 2 meters. Poison hemlock grows in diverse settings, including wooded areas, ditches, and waysides throughout the US, and may be mistaken for edible plants such as wild carrot; it also may be confused with water hemlock (C maculata).

Water hemlock is found in moist habitats, such as drainage ditches, marshes, and near bodies of fresh water. Water hemlock has compound leaves, small white or green flowers, and tuberous, large, hollow roots. Water Hemlock may reach a height of 6-8 feet.

Pathophysiology: Poison hemlock contains several alkaloid toxins that are structurally similar to nicotine. Initially, nicotinic activation from poison hemlock may lead to early CNS stimulation, headache, and ataxia. Nicotinelike effects at autonomic ganglia may cause tachycardia, salivation, mydriasis, and diaphoresis. In severe cases the acetylcholine receptors are overstimulated and finally fatigued, producing cholinergic blockade. The clinical effects therefore change from a stimulation phase to a depressant phase characterized by bradycardia, ascending motor paralysis, CNS depression, and respiratory paralysis.

Water hemlock contains cicutoxin, a potent toxin that acts as a noncompetitive gamma-aminobutyric acid (GABA) receptor antagonist. A single bite of the root, which contains the highest concentration of cicutoxin, has been reported to kill an adult. Ingestion of water hemlock produces GI symptoms (eg, salivation, nausea, emesis) within 15 minutes, rapidly followed by CNS effects (eg, excitation, convulsions, seizures, coma). Using a rat model, Uwai et al have shown cicutoxin derivates to bind and block GABA-chloride channels.

Frequency:

Mortality/Morbidity: Poison hemlock poisoning is potentially lethal with large ingestions; water hemlock fatalities have occurred following a few bites of the root.

Age: Younger patients with accidental ingestions are at an increased risk because of smaller body mass.

CLINICAL Section 3 of 10   Click here to go to the previous section in this topic Click here to go to the top of this page Click here to go to the next section in this topic

History: In cases of plant toxicity, history may be obscure and ingested plants may not be available for identification.

Physical:

Causes:

DIFFERENTIALS Section 4 of 10   Click here to go to the previous section in this topic Click here to go to the top of this page Click here to go to the next section in this topic

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 Section 5 of 10   Click here to go to the previous section in this topic Click here to go to the top of this page Click here to go to the next section in this topic

Imaging Studies:

Other Tests:

TREATMENT Section 6 of 10   Click here to go to the previous section in this topic Click here to go to the top of this page Click here to go to the next section in this topic

Prehospital Care: Secure airway, assist ventilation, and obtain IV access as needed.

Emergency Department Care: Rapidly assess and correct any life-threatening conditions. Since no antidote exists for either toxin, aggressive decontamination and supportive care are mainstays of treatment.

Consultations: A regional poison center or a medical toxicologist can assist with patient treatment and plant identification.

MEDICATION Section 7 of 10   Click here to go to the previous section in this topic <img src="/images/top4.gif" align="middle" width=31 height

41 posted on 03/13/2002 7:56:47 AM PST by aruanan
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To: seamole
I believe Socrates is remembered more for what he did in life, than the reason he died.
42 posted on 03/13/2002 8:10:55 AM PST by stuartcr
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To: Aquinasfan
He had learned the skill as a boy growing up in Poland.

As a youth I lived in NE Pennsylvania, amongst the Eastern Europeans. The only thing that would clear out the schools quicker than Deer hunting season, was the cry of, "Pipinkis are on the mountain!"

43 posted on 03/13/2002 8:28:53 AM PST by TC Rider
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To: Carry_Okie
Your letter was EXTREMELY informative... WOW!
44 posted on 03/13/2002 10:23:47 AM PST by Freedom2specul8
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To: Hellmouth
Some amanitas are edible, but you'll see some pretty interesting colors for the next several hours.
45 posted on 03/13/2002 10:24:16 AM PST by Britton J Wingfield
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To: aruanan
Sheesh! That's alot of good information. We need pictures now...
46 posted on 03/13/2002 10:25:53 AM PST by Freedom2specul8
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To: MeeknMing
I don't like celery. Now I wonder about those who put celery in their lunch salad. Is that really celery?
47 posted on 03/13/2002 10:26:55 AM PST by RightWhale
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To: ~Kim4VRWC's~
Exotic species are the biggest environmental problem we have, and it's only beginning.
48 posted on 03/13/2002 11:06:39 AM PST by Carry_Okie
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To: Conservobabe
Very Sad....I had a friend who was killed by a red wasp sting in Poetry TX a few years back and I remember they "harvested" his organs as well. It seemed like such a macabre term..."harvested". Your job must be tough indeed at times...especially with the wee ones.
49 posted on 03/13/2002 11:15:52 AM PST by wardaddy
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To: Clara Lou
Well no cows or calves ever died, so either they didn't eat it, or it didn't bother them. Perhaps they have an instinct not to eat poisonous weeds that humans do not have??
50 posted on 03/13/2002 11:27:53 AM PST by kassie
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