Toxic Plants (Deep Dive R32)
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 15 April 2022
⏱️ 16 minutes
🧾️ Download transcript
Summary
Cardiac Glycoside containing plants : Foxglove, Lilly of the Valley, Oleander, Squill
* Contain cardiac glycosides, which act as a negative chronotrope as well as a positive inotrope.* Patients present with nausea, vomiting, visual changes, bradycardia/arrhythmia, and may develop hyperkalemia – a poor prognostic factor* Treatment is Digibind/DigiFAB – look out for the side effects of hypokalemia as well as anaphylaxis.
Anticholinergic Alkaloid containing plants: Jimson Weed, Angels Trumpet, Deadly Nightshade
* Contain alkaloids that act as anticholinergics ; often used recreationally* Patients present with delirium/hallucinations, pupillary dilation, anhydrosis, hyperthermia, skin flushing, urinary retention* Treatment is support care, with physostigmine for severe cases – remember to go low and slow!
Toxic Mushrooms
* Important to distinguish between acute onset symptoms (<6hours) or delayed onset (6-24 hours)* Inocybe : acute onset ; cholinergic crisis; treat with atropine* Amanita Muscarina: acute onset; CNS toxicity – delrium, myoclonus, seizures ; supportive care and benzos as needed* Amanita Phalloides: delayed onset ; treat with NAC and maybe Silibinin* Phase 1: 6-24 hrs after ingestion, nausea vomiting diarrhea* Phase 2: transient recovery, 24-60 hours after ingestion* Phase 3: Hepatic / multisystem organ failure* Gyromitra: delayed onset; causes acute B6 deficiency leading to refractory seizures, treat with pyridoxine (vitamin B6) as well as usual seizure care.
Further Reading:
Stone Heart Syndrome – LITFL
Gyromitra – Indiana Poison Center
Anticholinergic Intoxication – EMCrit
Transcript
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| 0:00.7 | Hello, students. My name is Mike Estefan, and I thank you for joining me today for this month's deep dive episode on the EM Clerkship Podcast. |
| 0:11.6 | Now, I'm not going to lie to you guys. Today's episode is going to be unlike the vast majority of the content we produce. |
| 0:18.6 | That is, it isn't going to be particularly high yield, nor will it |
| 0:22.3 | likely help you impress your attendings during your shift. But it's one of my personal favorite |
| 0:27.6 | topics, and I think it's going to be really fun to go through. Part of being an ER doctor |
| 0:32.4 | is being able to handle any complaint at any time, even the once in a career type of cases. |
| 0:39.6 | So today's episode is going to be on toxic plant ingestions. |
| 0:44.8 | We are going to talk about plants containing cardiac glycosides, anticholinergic alkaloids, |
| 0:49.9 | and various types of poisonous mushrooms. |
| 0:53.0 | Before we begin, just a quick word from our sponsors at Pearson Rabbit's Insurance. |
| 0:58.5 | If you are a regular listener of our podcast, then you know how important own occupation |
| 1:04.1 | disability insurance is. Stephanie Pearson and her team at Pearson Rabbits have the experience |
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| 1:17.6 | Zach and I would not endorse a company that we did not personally believe in on our podcast. Stephanie Pearson is the real deal. |
| 1:26.6 | Please check out PearsonRavits at www Please check out Pearson Rabbits at www.com and sign up for a |
| 1:33.2 | consultation appointment today with Stephanie Pearson or one of her team members. Now, back to the |
| 1:39.0 | episode. Just a reminder like everything else on our podcast, this is not medical advice. |
| 1:46.0 | Furthermore, I am not a toxicologist. |
| 1:48.7 | If you have ingested one of these plants, please call 911 or your local emergency hotline |
| 1:53.8 | immediately. |
| 1:54.7 | And if you are treating a patient suspected of ingestion of one of these plants, you should |
| 1:59.1 | consult your local toxicologist or poison control center immediately. |
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