Central:

Peripheral:

1. Provide decontamination and supportive care, including oral administration of activated charcoal, airway protection, intravenous (IV) fluids, and vasopressors for hypotension resistant to IV fluids.

2. Treat hyperthermia.

3. Agitation can be treated with administration of a benzodiazepine. Haloperidol and phenothiazines should not be used because these agents may enhance toxicity.

4. Foley catheterization and nasogastric tube placement may be necessary if bladder distention and decreased gut motility develop, respectively.

Early Stage:

Late Stage:

Conium maculatum (poison hemlock) (Fig. 40-2) is also known as spotted hemlock, California or Nebraska fern, stinkweed, fool’s parsley, and carrot weed. It has a mousy odor and unpleasant bitter taste and burns the mouth and throat. All plant parts are poisonous; the roots are especially toxic. Poisoning may also occur after eating birds that have consumed poison hemlock.

Initially, stimulation causes:

1. Supportive care with particular attention to airway protection and ventilation is necessary.

2. Seizures should be treated with benzodiazepines and barbiturates.

3. Treat with IV fluids to ensure adequate urine output (1 mL/kg/hr).

4. Urine may be alkalinized with IV sodium bicarbonate to achieve a urine pH of 7.5.

5. Treating initial excessive adrenergic stimulation with phentolamine is not advised because this complicates the nicotinic blockade that follows.

6. Symptomatic bradycardia can be treated with atropine, and hypotension with IV fluids and inotropic agents (e.g., dopamine) if needed.