Prolonged ventilatory failure and flaccid quadriparesis after ingestion of poison hemlock

Abstract

Herein we describe a case of reversible coma, flaccid quadriparesis, and neuromuscular respiratory failure caused by intentional ingestion of poison hemlock.

Toxicologic Confounders of Brain Death Determination: A Narrative Review

“…We identified seven new substances that were associated with reversible loss of brainstem reflexes in overdose: doxepin [28], amoxapine [29], ethanol [41], bretylium [50], magnesium [54], tetrodotoxin [56], and zolpidem [57]. Snake envenomation [59][60][61][62], baclofen [34,[63][64][65], TCA [28,[66][67][68][69][70][71], bupropion [72][73][74][75], barbiturate [76,77], and bretylium [78] poisoning associated with reversible loss of cranial nerve reflexes may be more common than currently recognized given the many additional cases discovered in this review that did not meet the specific a priori definition of brain death mimic used in the study. [79].…”

Intravenous Poison Hemlock Injection Resulting in Prolonged Respiratory Failure and Encephalopathy

“…This patient had prolonged ventilatory requirements, requiring 14 days of mechanical ventilation until extubation, and 28 days until he had full neurologic recovery. [7] The largest case series is an Italian series from 1991 detailing 17 patients from 1972 to 1990 with hemlock toxicity from eating poisoned songbirds. All experienced neuromuscular toxicity, with four deaths from a combination of renal failure from rhabdomyolysis and prolonged paralysis [8].…”

Poison Hemlock

“…Affected individuals are often lethargic, and muscle weakness may lead to respiratory arrest requiring mechanical ventilation. Respiratory failure can be prolonged, lasting up to two weeks or in less-severe cases may recover completely in as little as 24 h [19,20]. Death is usually secondary to progressive paralysis and respiratory arrest.…”

“…Analysis of the plant specimen by gas chromatography-mass spectrometry for the presence of the piperidine alkaloids confirms the diagnosis. Variable results have been demonstrated with mass spectrometry utilizing patient urine, blood, and serum [1,19,22,23]. Analysis of cerebrospinal fluid has also been suggested [19].…”

“…Variable results have been demonstrated with mass spectrometry utilizing patient urine, blood, and serum [1,19,22,23]. Analysis of cerebrospinal fluid has also been suggested [19]. In cases in which poisoning has occurred after ingestion of toxic bird flesh, coniine has been isolated from the animal specimens [7].…”