Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • tachycardia
  • hypertension
  • hypotension
  • miosis
  • mydriasis
  • bradycardia
  • altered mental state
  • hallucinations
  • seizures

Other diagnostic factors

  • nausea
  • vomiting
  • abdominal pain
  • diarrhoea
  • dyspnea
  • skin flushing
  • dermatitis
  • dermatological/mucosal irritation
  • visible bleeding: epistaxis, melaena, haematuria, haematemesis, haemoptysis
  • headache
  • chest pain
  • muscle pain/swelling
  • skin pallor
  • easy bruising
  • petechial spotting
  • jaundice
  • asterixis
  • ascites
  • palmar erythema
  • spider angiomata
  • diaphoresis
  • dry skin
  • fever
  • urinary retention
  • constipation
  • hyperventilation
  • fasciculations
  • neuromuscular weakness
  • altered sensation

Risk factors

  • foraging for wild plants to eat
  • brewing wild plants into tea
  • children found or suspected of ingesting plants

Diagnostic investigations

1st investigations to order

  • ECG
  • FBC
  • serum electrolytes
  • serum creatinine
  • serum lactate
  • serum urea/creatinine
  • LFTs
  • INR
  • ABG
  • chest x-ray
Full details

Investigations to consider

  • troponin
  • serum digoxin levels
  • response to physostigmine
Full details

Treatment algorithm

ACUTE

Contributors

Authors VIEW ALL

Director

New Mexico Poison and Drug Information Center

Professor

Pharmacy Practice and Administrative Sciences

University of New Mexico

Albuquerque

NM

Disclosures

SS declares that she has no competing interests.

Medical Director

Program Director Medical Toxicology

Regional Poison Center at Children's Hospital of Michigan

Professor of Emergency Medicine and Pediatrics

Wayne State University School of Medicine

Detroit

MI

Disclosures

CKA owns stock from Merck. CKA writes chapters for various textbooks (Critical Care Toxicology and Intensive Care Medicine) and monographs for ToxEd.

Dr Susan Smolinske and Dr Cynthia K. Aaron would like to gratefully acknowledge Dr Gerald F. O'Malley and Dr Rika N. O'Malley, previous contributors to this monograph. GFOM and RNOM declare that they have no competing interests.

Peer reviewers VIEW ALL

Clinical Toxicologist

Emergency Consultant

Emergency Department

Royal Perth Hospital

Perth

Australia

Disclosures

JS declares that she has no competing interests.

Clinical Faculty

Department of Toxicology

Rocky Mountain Poison & Drug Center

Denver

CO

Disclosures

SP declares that he has no competing interests.

Poison Center Director

California Poison Control System, Sacramento Division

University of California Davis Medical Center

Sacramento

Associate Clinical Professor of Pharmacy

University of California San Francisco School of Pharmacy

San Francisco

Clinical Professor of Medicine

Volunteer Clinical Faculty

University of California Davis School of Medicine

Sacramento

CA

Disclosures

JA declares that she has no competing interests.

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