sodium-bicarbonate and Plant-Poisoning

Taxus species are known to be toxic and may result in significant dysrhythmias. Treatment of taxus induced cardiac dysrhythmias is based largely on case reports. We describe a case of a 24-year-old male with Taxus cuspidate (yew berry) toxicity initially treated with amiodarone bolus and infusion and subsequently managed with sodium bicarbonate boluses and continuous infusion.. The patient was found at home by his parents with witnessed "seizure-like"activity 2 hours after reportedly chewing and swallowing 168 yew seeds. The initial prehospital rhythm strip demonstrated ventricular tachycardia (VT); the patient was hypotensive with fluctuating levels of alertness. Prehospital cardioversion was attempted without success. Staff at the local presenting emergency department (ED) consulted toxicology for management of the presumed yew berry ingestion, complicated by cardiac dysrhythmias and mental status change with seizure. Amiodarone 300-mg IV and diazepam 5-mg IV were given. Cardioversion was attempted 4 times without change in the wide complex tachycardia, presumed to be VT, at a rate of 166. An amiodarone drip at 1 mg/min was initiated. The patient was transferred to an intensive care unit (ICU) at a regional toxicology center. On arrival to the toxicology center the patient was alert and verbally appropriate without complaints. Initial heart rate was 76 and regular with premature ventricular contractions (PVCs). A wide complex tachycardia associated with hypotension recurred; however, normal mental status was maintained. A bolus of 100 mEq of sodium bicarbonate (NaHCO3) was given intravenously followed by sodium bicarbonate infusion at 37.5 mEq/hr. The amiodarone drip was discontinued. Subsequent electrocardiograms (EKG's) revealed a prolonged, but steadily narrowing QRS complex. Ultimately, the QRS complex closed to 92 ms, with a rate of 94, PR 154 and a QT/QTc of 390/487.. This case describes successful treatment of an isolated Taxus cuspidate (yew berry) ingestion with significant toxicity initially with amiodarone bolus and infusion. Due to lack of significant change in telemetry recordings with amiodarone, treatment with sodium bicarbonate bolus and infusion was initiated. While the QRS narrowed significantly temporally related to the bicarbonate, it is difficult to determine if correction of the cardiac dysrhythmias was solely due to the sodium bicarbonate, or the synergism of sodium bicarbonate and amiodarone, or possibly spontaneous improvement due to taxine clearance. One should use caution while drawing conclusions from a single case; however, based on the clinical improvement of this patient, both with EKG recordings and vital signs, this report would suggest that isolated Taxus cuspidate ingestion from yew berry plants can be treated with sodium bicarbonate.

Topics: Amiodarone; Anti-Arrhythmia Agents; Antidotes; Drug Therapy, Combination; Electrocardiography; Humans; Injections, Intravenous; Male; Plant Poisoning; Seizures; Sodium Bicarbonate; Tachycardia, Ventricular; Taxus; Treatment Outcome; Young Adult

Fresh fescue (Festuca arundinacea) was obtained from farms where toxicity was encountered in cattle grazing the fescue. The fescue was dried in a forced draft oven at 60 degrees C and then ground. The dry ground fescue was extracted with ether and then re-extracted with either 1% sodium bicarbonate (NaHCO3), sodium hydroxide or hydrochloric acid. The residual ether was evaporated and the residue resuspended in ethyl alcohol diluted with water 1% (control) and 1 mL of the above extracts of fescue were given daily to rats, via stomach tube, beginning the seventh day after breeding. Two of the seven rats given the 1% NaHCO3 fraction of the extract of fescue gave birth to live young. One of these litters contained only five pups, with one being stillborn. Three of the seven rats aborted, one gave birth to seven stillborn pups and one female died during birth. All females fed the 1% NaHCO3 and the other extracts of the fescue gave birth to normal litters. Rats fed the ether extract which was re-extracted with 1% NaHCO3, acidified and re-extracted with ether, dried and resuspended in 1% NaHCO3 produced similar reproductive problems as those rats given the ether extract of fescue which was re-extracted only once with 1% NaHCO3. Therefore, it appears that the toxic entity(s) of fescue can be extracted and that infertility/abortion/still-birth ratio of rats may be used as a bioassay.

Topics: Administration, Oral; Animals; Bicarbonates; Female; Plant Extracts; Plant Poisoning; Plants, Toxic; Poaceae; Pregnancy; Rats; Reproduction; Sodium Bicarbonate; Solvents