ENVIRONMENTAL EMERGENCIESTREATMENT
■ Supportive therapy
■ Gastric decontamination (consider whole bowel irrigation)
■ Replace GI fluid losses with intravenous fluids.
■ Electrolyte replacement
Water Hemlock
Water hemlock grows throughout North America in wetlands or near streams.
It is tall with small white flowers.
Toxin = cicutoxin.
MECHANISM OFTOXICITY
■ Ingestion of plant →antagonism of GABA receptors and symptoms.
SYMPTOMS/EXAM
■ Rapid onset of symptoms after ingestion
■ Nausea/vomiting, abdominal pain
■ Mental status changes and severe status epilepticus
■ Death
TREATMENT
■ Supportive and aggressive gastric decontamination
■ Standard treatment for status epitepticus
Azalea
Exposure from ingestion of plant or contaminated honey
Toxin = andromedotoxins.
MECHANISM OF TOXICITY
■ Ingestion→increased permeability of Na+channels.
SYMPTOMS/EXAM
■ Nausea/vomiting
■ Bradycardia, hypotension
■ Progressive paralysis
■ Death (rare)
TREATMENT
■ GI decontamination
■ Supportive care
■ Atropine as needed for bradycardia
In water hemlock toxicity,
seizures are often refractory to
standard treatment.