Hemlock poisoning
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Hemlock Poisoning: Clinical Manifestations and Management
Introduction to Hemlock Poisoning
Hemlock poisoning, caused by the ingestion of plants from the Conium and Cicuta genera, is a serious and potentially fatal condition affecting both humans and animals. The primary toxic agents in these plants are coniine and cicutoxin, which have profound effects on the central nervous system (CNS) and other bodily systems1 2 3.
Toxic Agents in Hemlock Plants
Coniine and Gamma-Coniceine in Poison Hemlock
Poison hemlock (Conium maculatum) contains several piperidine alkaloids, with coniine and gamma-coniceine being the most significant. Coniine is predominant in mature plants and seeds, while gamma-coniceine is more abundant in the early growth stages1 4. These alkaloids cause neurotoxic effects, including CNS stimulation followed by depression, leading to symptoms such as muscular weakness, incoordination, and respiratory paralysis1 4.
Cicutoxin in Water Hemlock
Water hemlock (Cicuta spp.) is considered one of the most toxic plants known. The primary toxicant, cicutoxin, acts as a noncompetitive gamma-aminobutyric acid (GABA) antagonist, causing continuous neuronal depolarization, which can lead to violent convulsions and death1 3 5. Symptoms of water hemlock poisoning appear rapidly, often within 15 minutes of ingestion, and include excessive salivation, tremors, and convulsive seizures1 3.
Clinical Manifestations of Hemlock Poisoning
Neurological and Systemic Effects
Both poison hemlock and water hemlock poisoning present with severe neurological symptoms. These include CNS stimulation followed by depression, tremors, convulsions, and in severe cases, respiratory failure and death1 2 3 4. Additional symptoms may include nausea, vomiting, diarrhea, tachycardia, mydriasis, and rhabdomyolysis, which can lead to acute renal failure3 6 7.
Case Reports and Observations
Several case reports highlight the severity of hemlock poisoning. For instance, a 6-year-old girl experienced burning sensation in the mouth, hypersalivation, tremors, and ataxia after ingesting poison hemlock2. Another report detailed a 54-year-old man who suffered severe cicutoxin poisoning, requiring continuous intravenous infusion of thiopentone sodium to manage convulsions and metabolic acidosis10.
Management and Treatment of Hemlock Poisoning
Supportive Care and Symptom Management
The primary treatment for hemlock poisoning is supportive care. This includes airway management, seizure control, and decontamination if performed early3 6. In cases of severe poisoning, mechanical ventilation may be necessary to manage respiratory distress9. Hemodialysis has been used successfully in cases of renal failure3.
Specific Interventions
For convulsions caused by water hemlock, barbiturates, particularly short-acting agents, are considered life-saving8. In cases of poison hemlock ingestion, close observation for complications and supportive therapy, especially for respiratory function, are crucial6.
Conclusion
Hemlock poisoning is a life-threatening condition that requires prompt and aggressive supportive care. Understanding the toxic agents involved and the clinical manifestations can aid in the timely diagnosis and management of this poisoning. While the prognosis is generally good with prompt treatment, the severity of symptoms underscores the importance of immediate medical intervention.
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Most relevant research papers on this topic
Toxicoses in livestock from the hemlocks (Conium and Cicuta spp.).
Poison-hemlock toxicosis in livestock causes muscular weakness, incordination, trembling, depression, and death, while water-hemlock toxicosis causes violent convulsions and death.
Highly CitedHemlock (Conium Maculatum) Poisoning In A Child
Poison hemlock ingestion in children can lead to serious complications and even death, highlighting the importance of recognizing and treating plants resembling vegetables.
Case Report
Rigorous JournalPoisoning due to water hemlock
Ingestion of water hemlock can lead to serious complications and death, but prompt supportive care can improve the prognosis.
Literature ReviewPoison hemlock (Conium maculatum L.).
Poison hemlock is a common weed species with a wide range of biological effects, including nervous system effects, vomiting, trembling, and convulsions, leading to death in humans.
Highly CitedA CASE OF POISONING DUE TO EATING POISON-HEMLOCK (CICUTA MACULATA): WITH A REVIEW OF REPORTED CASES
Poison-hemlock's active agent, a cyanide compound, was identified in 1876, but the exact nature of the agent remains a subject of debate.
Conium maculatum intoxication: Literature review and case report on hemlock poisoning.
Hemlock poisoning is relatively rare, but can be fatal if not treated promptly, with symptoms including neurotoxicosis, tremor, vomiting, muscle paralysis, respiratory failure, rhabdomyolysis, and acute renal failure.
Literature ReviewClinical spectrum of accidental hemlock poisoning: neurotoxic manifestations, rhabdomyolysis and acute tubular necrosis.
Hemlock poisoning may cause neurotoxic manifestations, rhabdomyolysis, and acute tubular necrosis, requiring increased awareness to improve diagnostic and therapeutic procedures.
Case ReportHemlock water dropwort poisoning--a review.
Barbiturates, particularly short-acting agents, are life-saving in treating convulsions caused by hemlock water dropwort poisoning, making them the preferred treatment for this potentially fatal plant.
Case ReportHemlock water dropwort poisoning.
Hemlock water dropwort roots can cause severe poisoning in adults when mistaken for wild parsnip, causing convulsions, metabolic acidosis, and respiratory distress.
Case ReportCicutoxin poisoning (water hemlock)
Thiopentone sodium infusion effectively controlled body movements, metabolic acidosis, and cholinergic crisis in a severe case of water hemlock poisoning.
Case Report