Jump to content

Cicuta: Difference between revisions

From Wikipedia, the free encyclopedia
Browse history interactively
← Previous editNext edit →
Content deleted Content added
VisualWikitext
→‎Treatment: missing word
Line 66: Line 66:
Initial treatment of poisoning may include [[gastrointestinal]] decontamination with [[activated charcoal]]. Decontamination is typically only performed if a potentially toxic amount of plant matter has been ingested up to 1 hour previously and the patient has an normal intact [[airway]] or has been [[Intubation|intubated]].<ref name="Schep"/> There is no specific antidote for water hemlock poisoning and treatment mainly consists of supportive care. Treatment may include control of [[seizure]]s with the administration of a [[benzodiazepine]]s such as [[lorazepam]] or [[diazepam]], or if seizures are refractory to this treatment, a [[barbituate]] such as [[phenobarbital]] is administered.<ref name="Schep"/> The [[anticonvulsant]] [[phenytoin]] is not recommended in water hemlock poisoning as it has not been shown to be effective for seizure control following this poisoning.<ref name="Starreveld">{{cite journal |author=Starreveld E, Hope E |title=Cicutoxin poisoning (water hemlock) |journal=Neurology |volume=25 |issue=8 |pages=730–4 |year=1975 |month=August |pmid=1171406}}</ref> Treatment with high doses of benzodiazepines or barbituates may cause respiratory depression and respiratory support including [[intubation]] and [[mechanical ventilation]] is required in these patients.<ref name="Schep"/> Continuous [[electroencephalography]] monitoring is recommended.<ref name="Schep"/>
Initial treatment of poisoning may include [[gastrointestinal]] decontamination with [[activated charcoal]]. Decontamination is typically only performed if a potentially toxic amount of plant matter has been ingested up to 1 hour previously and the patient has an normal intact [[airway]] or has been [[Intubation|intubated]].<ref name="Schep"/> There is no specific antidote for water hemlock poisoning and treatment mainly consists of supportive care. Treatment may include control of [[seizure]]s with the administration of a [[benzodiazepine]]s such as [[lorazepam]] or [[diazepam]], or if seizures are refractory to this treatment, a [[barbituate]] such as [[phenobarbital]] is administered.<ref name="Schep"/> The [[anticonvulsant]] [[phenytoin]] is not recommended in water hemlock poisoning as it has not been shown to be effective for seizure control following this poisoning.<ref name="Starreveld">{{cite journal |author=Starreveld E, Hope E |title=Cicutoxin poisoning (water hemlock) |journal=Neurology |volume=25 |issue=8 |pages=730–4 |year=1975 |month=August |pmid=1171406}}</ref> Treatment with high doses of benzodiazepines or barbituates may cause respiratory depression and respiratory support including [[intubation]] and [[mechanical ventilation]] is required in these patients.<ref name="Schep"/> Continuous [[electroencephalography]] monitoring is recommended.<ref name="Schep"/>


Further treatment for complications of [[metabolic acidosis]], [[rhabdomyolysis]], [[hyperthermia]], or [[hypotension]] may be required. Hypotension is usually treated with intravenous [[fluid replacement]], but the administration of [[dopamine]] or [[norepinephrine]] may be required to restore blood pressure.<ref name="Schep"/> Metabolic acidosis is treated by administering [[sodium bicarbonate]].<ref>{{cite journal |author=Ball MJ, Flather ML, Forfar JC |title=Hemlock water dropwort poisoning |journal=Postgrad Med J |volume=63 |issue=739 |pages=363–5 |year=1987 |month=May |pmid=3671269 |pmc=2428460 }}</ref> The managemnet of rhabdomyolysis includes ensuring adequate hydration and urinary alkalinization; a complicatin of rhabdomyolysis is acute renal failure which may require management with [[hemodialysis]].<ref name="Schep"/> Hemodialysis does not, however, remove cicutoxin from the blood.<ref name="Schep"/>
Further treatment for complications of [[metabolic acidosis]], [[rhabdomyolysis]], [[hyperthermia]], or [[hypotension]] may be required. Hypotension is usually treated with intravenous [[fluid replacement]], but the administration of [[dopamine]] or [[norepinephrine]] may be required to restore blood pressure.<ref name="Schep"/> Metabolic acidosis is treated by administering [[sodium bicarbonate]].<ref>{{cite journal |author=Ball MJ, Flather ML, Forfar JC |title=Hemlock water dropwort poisoning |journal=Postgrad Med J |volume=63 |issue=739 |pages=363–5 |year=1987 |month=May |pmid=3671269 |pmc=2428460 }}</ref> The managemnet of rhabdomyolysis includes ensuring adequate hydration and urinary alkalinization; a complicatin of rhabdomyolysis is acute renal failure which may require management with [[hemodialysis]].<ref name="Schep"/> However, hemodialysis, [[hemoperfusion]] or other [[extracorporeal]] techniques do remove cicutoxin from the blood and are therefoe not useful in [[Poison#Enhanced_excretion|enhancing elimination]].<ref name="Schep"/>


==See also==
==See also==

Revision as of 06:54, 17 August 2009

Cicuta
Cicuta virosa
Scientific classification
Kingdom:
Plantae
(unranked):
Angiosperms
(unranked):
Eudicots
(unranked):
Asterids
Order:
Apiales
Family:
Apiaceae
Genus:
Cicuta

Species

Cicuta bulbifera
Cicuta douglasii
Cicuta maculata
Cicuta virosa

Cicuta is a small genus of four species of highly poisonous flowering plants in the family Apiaceae, native to temperate regions of the Northern Hemisphere, mainly North America and Europe. Given the common names Water Hemlock, Cowbane, or Poison Parsnip, they are perennial herbaceous plants which grow up to 2.5 m tall. The species grow in wet meadows, along streambanks and other wet and marshy areas.

Although water hemlock bears a superficial resemblance to poison hemlock (Conium genus)—and is a member of the same family—the species are distinct.

Description

Cicuta douglasii, showing distinctive umbrella shaped umbel.

Cicuta spp. are perennial plants that are all similar in morphology, growing up to a maximum of 2.5 m in height. The stem of the plant is branching, erect, smooth and hollow (except for partitions at the junction of the leaves and stem), sometimes being purple-striped, or mottled (typically only C. Malculata has the purple stripes or spots). Attached to the base of the stem is a tuberous root with thickened rootstocks. The rootstocks are multichambered and contain a yellowish oily liquid which turns reddish brown on exposure to air and emits a characteristic smell of raw parsnip. The alternate leaves are 2 or 3 pinnately compound. The leaflets are lanceolate, serrate, 5 to 10 cm in length, and sharply toothed. The plants flowers are small with green or white petals clustered in an umbrella shape (umbel) characteristic to this family; the umbel measures 5 to 10 cm across. The plants produce a cyclindrical fruit which is 4 to 6 mm in length..[1][2][3]

Species

There are four species in the Cicuta genus:[1]

Other species names such as Cicuta bolanderi and Cicuta californica are older names now recognized to be varieties of the widespread Cicuta maculata.[3]

Similar species

Members of the family Apiaceae have many characteristics in common and bear close resemblance to each other all having white flowers in large compound umbels. Cicuta spp. plants are often mistaken for edible plants such as sweet flag (Acorus calamus), kvanne (Angelica archangelica).wild celery (Apium graveolens), pignut (Conopodium majus), wild carrot (Daucus carota), watercress (Nasturtium spp.), wild ginseng (Panax quinquefolius), wild parsnip (Pastinaca sativa), and water parsnip (Berula spp.).[1] One of the more common misidentifications is water hemlock and water parsnip, both have clusters of small white flowers shaped like umbrellas, and both have the same habitat near the shore line of lakes, and rivers. Differences between water parsnip and water hemlock include water parsnip having leaves only once compound while water hemlock has leaves which are two or three times compound. Water hemlock also has a large swelling at the stem base which water parsnips lacks; while water hemlock has bracts at the base of each small flower cluster, not at the base of the main flower head.[4] Water parsnip similarly has small bracts at the base of flowers but also has bracts at the main flower head.[5]

Other plants that looks similar to Cicuta spp. but are not edible are the Yarrow, (Achillea millefolium, also commonly known as Common Yarrow, Gordaldo, Nosebleed plant, Old Man's Pepper, Sanguinary, Milfoil, Soldier's Woundwort, Thousand-leaf, and Thousand-seal), Cow Parsnip (heracleum lanatum, also known as Heracleum maxinium, Indian Celery or Pushki) or hogweed (Heracleum sphondylium). Features which differentiate them include the yarrow having feathery looking leaves which are pinnately separated into small narrow segments,[6] while cow parsnip and hogweed have large, broad leaves, and an unpleasant odor.[7]

Additionally, there can be confusion between the various water hemlock species and poison hemlock (Conium maculatum)[8] as the common name hemlock is applied to both Cicuta and Conium maculatum. Both are poisonous and can be differentiated by differences in their root structure. Water hemlock has a branched root systems with tubules while poison hemlock has a single tap root.[1] Another reliable method to identify water hemlock is to examine the leaf veins. Water Hemlock is unique in the Apiaceae family in that it has leaf veins which terminate in the notches between the leaf tips rather than extend to the tip of the leaf as is found in the leaf structure of other members of this family.[2]

Distribution and habitat

Cicuta spp. are found growing across North America and Europe. Typically they grow in wet habitats usually alongside ponds and streams, in marshes or swamps, or areas that are swampy at least part of the year. Plants can also be found growing in water.[2][3] Of the 4 species Cicuta maculata has the most widespread distribution occurring across the majority of North America. Cicuta bulbifera also has a relatively large distribution, found throughout Northern North America. Cicuta douglasii is found in the northwest corner of North America, while Cicuta virosa is only found in central Europe and in the far north of North America.[1][3]

Toxicity

Cicutoxin is the major poison in Cicuta spp. plants.

All members of Cicuta except C. bulbifera contain high levels of the poisonous principle cicutoxin, an unsaturated aliphatic alcohol that is present at all stages of growth and in all parts of the plant. It is the most concentrated in the roots and the roots appear to be the most toxic in the early spring.[1] Cicutoxin is highly poisonous and water hemlock is considered one of North America's most toxic plants.[1][9] Ingestion of Cicuta can be fatal in humans and there are reports in the medical literature of severe poisoning and death as early as 1670.[1] A number of people have also died following ingestion of plant material in the 20th and 21st century.[10][11][12][13][14]

The exact toxic dose of plant material is unknown; it is thought ingestion of water hemlock in any quantity can result in poisoning and very small amounts may lead to death in humans.[1] Poisoning has been reported following children blowing whistles made from the the hollow stem of water hemlock plants.[15] Intoxication has also been reported following skin contact with the plant; a case was reported where a family of 5 people rubbed the plant onto the skin and were poisoned with 2 children dying.[16] Livestock have long been the worst affected, leading to the common name "cowbane". Poisoning in livestock typically occurs following ingestion of roots of the plant and may cause death in the animal in as little as 15 minutes.[17][18]

Symptoms

Upon consumption, both in humans and other species, the symptoms of poisoning are mainly characterized by generalized seizures.[1] The onset of symptoms following ingestion may be as soon as 15 minutes post ingestion. Initial symptoms reported may include nausea, vomiting, abdominal pain, tremors, confusion, weakness, dizziness, and drowsiness;[9] although the rapid onset of seizure activity may be the first sign presenting following poisoning. Seizures are usually described as clonic or tonic–clonic.[1] Complications of ongoing seizure activity include hyperthermia, metabolic acidosis, cerebral edema, coagulopathy, rhabdomyolysis, and kidney failure.[1][19][20] Additional neurological symptoms may include hallucinations, delirium, paresthesia, mydriasis, and coma.[1][9] Cardiovascular symptoms include alternating bradycardia or tachycardia[21] and alternating hypotension and hypertension.[22] Other cardiac effects may include ECG abnormalities such as widening of the PR interval, supraventricular tachycardia, and ventricular fibrillation.[1] [10][23] Symptoms of excess salivation, wheezing, respiratory distress, and apnea have also been reported.[1]

Deaths usually occur from respiratory failure or ventricular fibrillation secondary to ongoing seizure activity. Poisoned people who recover usually regain consciousness and seizures cease within 24 to 48 hours of poisoning, although seizures may persist for up to 96 hours.[1] There are occasional long-term effects such as retrograde amnesia of the events leading to intoxication and the intoxication itself.[11][22][24][25] Other ongoing mild symptoms may include restlessness, muscle weakness, twitching, and anxiety.[1][26] Complete resolution of symptoms may take a number of days or, in some cases, these ongoing symptoms may persist for months after the intoxication.[1]

Diagnosis

Water hemlock poisoning is usually diagnosed following a history of plant ingestion and symptoms of abrupt onset of seizures.[12][27] Laboratory tests to determine the presence of cicutoxin in the blood such as spectrofluorimetry, high pressure liquid chromatography, thin layer chromatography, and mass spectrometry have been used to detect cicutoxin but these tests are not performed routinely in hospital laboratories.[1] If a sample of the plant ingested has been retained, diagnosis can be confirmed by having the plantidentiifed by a botanist.[1]

Treatment

Initial treatment of poisoning may include gastrointestinal decontamination with activated charcoal. Decontamination is typically only performed if a potentially toxic amount of plant matter has been ingested up to 1 hour previously and the patient has an normal intact airway or has been intubated.[1] There is no specific antidote for water hemlock poisoning and treatment mainly consists of supportive care. Treatment may include control of seizures with the administration of a benzodiazepines such as lorazepam or diazepam, or if seizures are refractory to this treatment, a barbituate such as phenobarbital is administered.[1] The anticonvulsant phenytoin is not recommended in water hemlock poisoning as it has not been shown to be effective for seizure control following this poisoning.[27] Treatment with high doses of benzodiazepines or barbituates may cause respiratory depression and respiratory support including intubation and mechanical ventilation is required in these patients.[1] Continuous electroencephalography monitoring is recommended.[1]

Further treatment for complications of metabolic acidosis, rhabdomyolysis, hyperthermia, or hypotension may be required. Hypotension is usually treated with intravenous fluid replacement, but the administration of dopamine or norepinephrine may be required to restore blood pressure.[1] Metabolic acidosis is treated by administering sodium bicarbonate.[28] The managemnet of rhabdomyolysis includes ensuring adequate hydration and urinary alkalinization; a complicatin of rhabdomyolysis is acute renal failure which may require management with hemodialysis.[1] However, hemodialysis, hemoperfusion or other extracorporeal techniques do remove cicutoxin from the blood and are therefoe not useful in enhancing elimination.[1]

See also

Footnotes

  1. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa Schep LJ, Slaughter RJ, Becket G, Beasley DM (2009). "Poisoning due to water hemlock". Clin Toxicol (Phila). 47 (4): 270–8. doi:10.1080/15563650902904332. PMID 19514873. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  2. ^ a b c Kingsbury, J.M. (1964). Poisonous Plants of the United States and Canada (3 ed.). Englewood Cliffs (NJ): Prentice-Hall. pp. 373–9. ISBN 0-136-85016-2.
  3. ^ a b c d Burrows, George (2001). Toxic plants of North America. Ames (IA): Iowa State Press. pp. 49–54. ISBN 0813822661. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  4. ^ "Western Water Hemlock". Government of Saskatchewan. Retrieved 2008-08-03.
  5. ^ "Water Parsnip". Government of Saskatchewan. Retrieved 2008-08-03.
  6. ^ "Common yarrow". University of Illinois. Retrieved 2009-08-13.
  7. ^ "Heracleum lanatum". University of Saskatchewan. Retrieved 2008-08-03. {{cite web}}: Cite has empty unknown parameter: |coauthors= (help)
  8. ^ Hollman A (1988). "Hemlock poisoning". Br Med J (Clin Res Ed). 296 (6618): 361. {{cite journal}}: Cite has empty unknown parameter: |month= (help)
  9. ^ a b c Mutter L (1976). "Poisoning by Western Water Hemlock". Can J Public Health. 67 (5): 386. PMID 991044.
  10. ^ a b Centers for Disease Control and Prevention (CDC) (1994). "Water hemlock poisoning--Maine, 1992". MMWR Morb. Mortal. Wkly. Rep. 43 (13): 229–31. PMID 8145712. {{cite journal}}: Unknown parameter |month= ignored (help)
  11. ^ a b Landers D, Seppi K, Blauer W (1985). "Seizures and death on a white river float trip. Report of water hemlock poisoning". West. J. Med. 142 (5): 637–40. PMC 1306130. PMID 4013278. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  12. ^ a b Heath KB (2001). "A fatal case of apparent water hemlock poisoning". Vet Hum Toxicol. 43 (1): 35–6. PMID 11205076. {{cite journal}}: Unknown parameter |month= ignored (help)
  13. ^ Vogt E (1951). "[Water hemlock (Cicuta virosa) poisoning; report of two cases.]". Tidsskr. Nor. Laegeforen. (in Norwegian). 71 (18): 577–8. PMID 14884156. {{cite journal}}: Unknown parameter |month= ignored (help)
  14. ^ Withers LM, Cole FR, Nelson RB (1969). "Water-hemlock poisoning". N. Engl. J. Med. 281 (10): 566–7. PMID 5800524. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  15. ^ Miller MM (1933). "Water hemlock poisoning". J Am Med Assoc. 101 (11): 852–3.
  16. ^ Egdahl A (1911). "A case of poisoning due to eating poison hemlock (Cicuta maculata) with a review of reported cases". Arch Intern Med. 7: 348–56. {{cite journal}}: Cite has empty unknown parameter: |month= (help)
  17. ^ "Water hemlock (Cicuta douglasii)". United States Department Of Agriculture. 02/07/2006. Retrieved 2009-13-06. {{cite web}}: Check date values in: |accessdate= and |date= (help); Cite has empty unknown parameter: |coauthors= (help)
  18. ^ Panter KE, Keeler RF, Baker DC (1988). "Toxicoses in livestock from the hemlocks (Conium and Cicuta spp.)". J. Anim. Sci. 66 (9): 2407–13. PMID 3049497. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  19. ^ Carlton BE, Tufts E, Girard DE (1979). "Water hemlock poisoning complicated by rhabdomyolysis and renal failure". Clin. Toxicol. 14 (1): 87–92. doi:10.3109/15563657909030117. PMID 35306.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  20. ^ Short J (2006). "Water hemlock poisoning". Emerg Nurse. 14 (7): 18–9. PMID 17140092. {{cite journal}}: Unknown parameter |month= ignored (help)
  21. ^ Gompertz LM (1926). "Poisoning with water hemlock (Cicuta maculata). Report of seventeen cases". JAMA. 87: 12778. {{cite journal}}: Cite has empty unknown parameter: |month= (help)
  22. ^ a b Costanza DJ, Hoversten VW (1973). "Accidental ingestion of water hemlock. Report of two patients with acute and chronic effects". Calif Med. 119 (2): 78–82. PMC 1455113. PMID 4726956. {{cite journal}}: Unknown parameter |month= ignored (help)
  23. ^ Kass A, Pedersen H (1951). "[Water hemlock (cicutoxin) poisoning; review and personal observations.]". Tidsskr. Nor. Laegeforen. (in Norwegian). 71 (18): 579–80. PMID 14884157. {{cite journal}}: Unknown parameter |month= ignored (help)
  24. ^ Knutsen OH, Paszkowski P (1984). "New aspects in the treatment of water hemlock poisoning". J. Toxicol. Clin. Toxicol. 22 (2): 157–66. PMID 6502788.
  25. ^ Stratton MR (1919). "Water hemlock poisoning". Colorado Med. 16: 104–11.
  26. ^ Applefeld JJ, Caplan ES (1979). "A case of water hemlock poisoning". JACEP. 8 (10): 401–3. doi:10.1016/S0361-1124(79)80404-9. PMID 491328. {{cite journal}}: Unknown parameter |month= ignored (help)
  27. ^ a b Starreveld E, Hope E (1975). "Cicutoxin poisoning (water hemlock)". Neurology. 25 (8): 730–4. PMID 1171406. {{cite journal}}: Unknown parameter |month= ignored (help)
  28. ^ Ball MJ, Flather ML, Forfar JC (1987). "Hemlock water dropwort poisoning". Postgrad Med J. 63 (739): 363–5. PMC 2428460. PMID 3671269. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
Retrieved from "https://en.wikipedia.org/w/index.php?title=Cicuta&oldid=308435889"