1/7. A rare ingestion of the Black Locust tree.BACKGROUND: The Black Locust (robinia Pseudoacacia) tree contain toxalbumins, robin and phasin, that exert their toxic effects by inhibition of protein synthesis. Despite the potential dangers of Black Locust intoxication, reports of human toxicity after ingestion are rare. We report the first human intoxication of Black Locust bark in north america in over one hundred years. CASE REPORT: An eight-year-old male was brought to the emergency department 6 hours after chewing and expelling the Black Locust bark. He presented with emesis, which began approximately 2.5 hours after exposure. His vital signs were as follows: oral temperature, 97.5 degrees F; blood pressure, 128/75 mmHg; heart rate, 114 beats per minute; respiratory rate, 15 breaths per minute. Initial treatment included 4 mg i.v. ondansetron, which resolved the vomiting, one dose of activated charcoal, and intravenous fluids. He was then admitted to the intensive care unit (ICU) for observation of signs of toxicity. Laboratory findings were unremarkable except for a white blood cell of 18.4 K/uL and an elevated alkaline phosphatase of 183 U/L. The patient remained asymptomatic throughout his stay in the ICU and was discharged on the fifth day of admission with a normal white blood cell of 4.1 K/uL and an alkaline phosphatase of 251 U/L. CONCLUSION: patients with clinical toxicity following the ingestion of Black Locust are expected to do well with supportive care and observation.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/7. Near-fatal yew berry intoxication treated with external cardiac pacing and digoxin-specific FAB antibody fragments.The case of a 5-year-old girl who survived a near-fatal ingestion of yew plant leaves after treatment with CPR, transcutaneous pacing, and digoxin-specific FAB antibody fragments is presented. Multiple rhythm disturbances, including profound bradycardia, occurred. She required endotracheal intubation, external chest compressions, and application of a transcutaneous pacemaker. Paced cardiac contractions produced a dramatic improvement in her blood pressure and clinical condition. Two empiric injections of digoxin-specific FAB antibody fragments were administered, after which cardiac function and rhythm gradually improved. She was discharged in her normal state of health three days later. Yew leaves and berries contain several alkaloids that can produce fatal conduction disturbances. Transcutaneous cardiac pacemakers may be lifesaving for patients with transient cardiac toxicity from drug or toxin ingestions. In addition, cross-reactivity between digoxin-specific FAB antibodies and the alkaloids in the yew plant may exist and may have therapeutic importance, although this mechanism was unlikely to have helped our patient.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/7. poisoning due to ingestion of Veratrum viride (false hellebore).We present six cases of poisoning due to ingestion of Veratrum viride (false hellebore) and review the physiology of veratrum alkaloids. Significant bradycardia and hypotension can occur after intoxication by veratrum plants, which grow widely in swampy areas of the eastern and western united states. nausea and vomiting also occur typically after ingestion. atropine is the mainstay of therapy, but pressors may be required to maintain blood pressure. Cases of veratrum poisoning have not been widely reported in the emergency medicine literature.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/7. A case of water hemlock poisoning.water hemlock is a ubiquitous plant that can be mistaken for a turnip as in the case reported. Oral ingestion causes an explosive illness consisting of nausea, vomiting, abdominal cramps, and grand mal seizures that can progress to cyanosis and death. In the reported case a 30-year old man was found semi-comatose some 75 minutes after ingesting a "turnip". The history revealed profuse emesis shortly after eating lunch that changed from bile to frank blood. There was a mean orthostatic blood pressure change of 30 torr, with an increase in the heart rate of 10%. neurologic examination revealed a lethargic patient. Following administration of 4 liters of Ringer's lactate the patient's blood pressure stabilized and with continued isotonic fluid maintenance he improved rapidly. This case indicates that appropriate management should be directed toward protecting the patient's airway from gastric aspiration, restoring the intravascular and extracellular volume deficit, and controlling cerebral edema.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
5/7. Three cases of zigadenus (death camus) poisoning.Three cases are reported where 1/2-2 bulbs of zigadenus were ingested. This resulted in vomiting, cramping and nausea, starting within 1-2 hours and lasting 4-5 hours. Both the heart rate and blood pressure were affected, generally, but not consistently, decreased. atropine, when used for the cardiovascular effects, increased the heart rate, but had minimal action on the blood pressure. There was little toxic effect on respiration, central nervous system, or temperature. The one case of increased temperature was though to be due to an unrelated illness. Treatment of such cases should include emesis (or lavage, if emesis is contraindicated), activated charcoal, and saline cathartic. Symptomatic cases need an iv and possible administration of atropine, a sympathometic and/or a ganglionic blocking agent. Since there is considerable variation in what symptoms will be seen with the different species of zigadenus, each case must be treated symptomatically; first with good supportive care, then possibly with administration of the above agents.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
6/7. Beneficial effect of digoxin-specific Fab antibody fragments in oleander intoxication.A 24-year-old man presented to the emergency department with nausea, vomiting, abdominal pain, and an acute confusional state of 6 hours' duration. Ten hours before admission, he had ingested a mixture of orange juice and six ground leaves, later identified as nerium oleander (common pink oleander) leaves. His blood pressure was 100/80 mm Hg, and his pulse rate was irregular at 40/min. He was disoriented and his speech was dysarthric. Twelve-lead electrocardiography revealed a complete atrioventricular block, with a nodal escape rhythm of 40/min and diffuse ST depression. The presumptive diagnosis of acute oleander intoxication was confirmed by the detection of digoxin (1.0 nmol/L [0.8 ng/mL]) on radioimmunoassay. Despite intensive therapy, the patient's hemodynamic condition deteriorated. His blood pressure decreased to 70/40 mm Hg; he became oliguric and nonresponsive to external stimuli; and his potassium concentration rose to 6.8 mmol/L. Eighteen hours after admission, an empiric 480-mg dose of digoxin-specific Fab antibody fragments was administered intravenously over 30 minutes. Within minutes of the initiation of immunotherapy, the patient woke up; his blood pressure rose to 90/50 mm Hg; and he regained a sinus rhythm of 68/min with a prolonged PR interval. His potassium concentration decreased to 5.1 mmol/L within 15 minutes and normalized within 1 hour of therapy initiation. One day later, the 1 degree atrioventricular block disappeared, but the ST depression persisted for an additional 6 days. The value of digoxin-specific Fab antibody fragments in the treatment of plant glycoside and, in particular, oleander intoxication is discussed.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
7/7. Intoxication from Veratrum album.Two new cases of Veratrum poisoning are described. Clinical symptoms occurred quickly, within 30 min. vomiting, a fall in blood pressure and bradycardia were observed. The outcome was favourable in both cases, producing a cure without sequellae. Examination of the literature showed that such cases are nearly always accidental, resulting from the difficulty in distinguishing Veratrum album and gentiana.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |