GI symptoms
Administration of activated charcoal (0.5-1.0 gm/kg up to 50g) within 1 hour
No prospective studies so recommendations are case dependent
Avoid in patients actively vomiting or with altered mental status
Gastric lavage
Typically not recommended in most toxic ingestions due to risk of aspiration but applicable in plant ingestions because of large volume of organic material ingested
Osmotic laxatives
If in austere environment with limited resources and delayed extraction time:
0.5 ounces (15mL) Syrup of Ipecac orally with 500mL of water
Manual induction of vomiting
Cardiotoxic effects
Hypotension
IV fluids
Vasopressors if hypotension is persistent
Bradycardia
Atropine
Arrhythmias
Monitor patient on telemetry until 24hrs after symptomatic resolution
Lidocaine, procainamide, flecainide, or amiodarone
Neurotoxic effects
Seizure activity
Benzodiazepines
Respiratory failure
May require intubation and mechanical ventilation
Suicidal ideation
Obtain detailed history as to why plant was ingested
If suicidal ideation is suspected, consider psychiatric referral
Administration of activated charcoal (0.5-1.0 gm/kg up to 50g) within 1 hour
No prospective studies so recommendations are case dependent
Avoid in patients actively vomiting or with altered mental status
Gastric lavage
Typically not recommended in most toxic ingestions due to risk of aspiration but applicable in plant ingestions because of large volume of organic material ingested
Osmotic laxatives
If in austere environment with limited resources and delayed extraction time:
0.5 ounces (15mL) Syrup of Ipecac orally with 500mL of water
Manual induction of vomiting
No prospective studies so recommendations are case dependent
Avoid in patients actively vomiting or with altered mental status
Typically not recommended in most toxic ingestions due to risk of aspiration but applicable in plant ingestions because of large volume of organic material ingested
0.5 ounces (15mL) Syrup of Ipecac orally with 500mL of water
Manual induction of vomiting
Hypotension
IV fluids
Vasopressors if hypotension is persistent
Bradycardia
Atropine
Arrhythmias
Monitor patient on telemetry until 24hrs after symptomatic resolution
Lidocaine, procainamide, flecainide, or amiodarone
IV fluids
Vasopressors if hypotension is persistent
Atropine
Monitor patient on telemetry until 24hrs after symptomatic resolution
Lidocaine, procainamide, flecainide, or amiodarone
Seizure activity
Benzodiazepines
Benzodiazepines
May require intubation and mechanical ventilation
Obtain detailed history as to why plant was ingested
If suicidal ideation is suspected, consider psychiatric referral
Aconitum toxicity
Accidental Ingestion vs suicide attempt
Ovarian hyperstimulation syndrome
Aconitum Poisoning
Molar pregnancy
Other toxic plant ingestion
Septic abortion
Including plants with similar symptoms and management such as Veratrum spp 