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Du EY, Nellore A, Pfeifer C, Norfleet G, Scalzo A, Riley SB. Dying to be with yew. TOXICOLOGY COMMUNICATIONS 2021. [DOI: 10.1080/24734306.2021.1918898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Eric Y. Du
- Department of Medicine, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Aditya Nellore
- Department of Medicine, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Courtney Pfeifer
- Forensic Toxicology Laboratory, St. Louis County Department of Health, St. Louis, MO, USA
| | - Gershom Norfleet
- St. Louis County Medical Examiner’s Office, St. Louis County Department of Health, St. Louis, MO, USA
| | - Anthony Scalzo
- Department of Internal Medicine, Medical Toxicology, Division of Emergency Medicine, Department of Surgery, Department of Pediatrics, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Sarah B. Riley
- Department of Pathology, St. Louis University School of Medicine, St. Louis, MO, USA
- Department of Pediatrics, St. Louis University School of Medicine, St. Louis, MO, USA
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Alarfaj M, Goswami A. Cardiotoxicity in yew berry poisoning. Am J Emerg Med 2021; 50:812.e1-812.e4. [PMID: 34049761 DOI: 10.1016/j.ajem.2021.05.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/08/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022] Open
Abstract
Yew plants (Taxus species) represent a genus of plants known to be highly toxic, though lethal intoxication is rare. The majority of deaths in yew berry poisonings occur due to its cardiotoxic effect, mediated through generation of a number of fatal tachy- and brady-arrhythmias. However, there are no guidelines on the most effective management in these cases, and interventions vary greatly between published reports. Here we report a case of a 20-year-old female who presented with refractory lethal arrythmia and shock refractory to conventional therapy. She presented to the emergency department and promptly required airway management and hemodynamic support necessitating intensive care unit management. She received many antiarrhythmics, digoxin immune Fab, lipid emulsification, and eventually transvenous pacemaker insertion for overdrive pacing. Despite our interventions, our patient ultimately died after a decision to withdraw care. We also reviewed 43 reports of yew poisoning cases described in the literature. We discuss the most common strategies used to treat such patients including gastric decontamination, antiarrhythmics, electrical pacing, extracorporeal life support and other therapies. We need better understanding of this condition, to identify which therapies offer maximal benefit and to optimize outcomes for this rare but often devastating toxidrome.
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Affiliation(s)
| | - Ankur Goswami
- Department of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Cerrato N, Calzolari G, Tizzani P, Actis Perinetto E, Dellavalle A, Aluffi E. Bizarre and scary ECG in yew leaves poisoning: Report of successful treatment. Ann Noninvasive Electrocardiol 2018; 23:e12535. [PMID: 29488680 DOI: 10.1111/anec.12535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 01/15/2018] [Indexed: 11/30/2022] Open
Abstract
Yew leaves poisoning is a rare life-threatening intoxication, whose diagnosis can be difficult. Initial symptoms are nausea, vomiting, abdominal pain, dizziness, tachycardia, muscle weakness, confusion, beginning within 1 hr from ingestion and followed by bradycardia, ventricular arrhythmias, ventricular fibrillation, severe hypotension, and death. Taxine-derived alkaloids are responsible for the toxicity of the yew leaves, blocking sodium and calcium channels, and causing conduction abnormalities. Because of lack of a specific antidote and limited efficacy of common antiarrhythmic drugs, prompt diagnosis, detoxification measures, and immediate hemodynamic support (also with transvenous cardiac stimulation) are essential.
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Affiliation(s)
| | | | - Pietro Tizzani
- Emergency Department, Ospedale San Lazzaro, Alba, CN, Italy
| | | | | | - Enzo Aluffi
- Emergency Department, Ospedale San Lazzaro, Alba, CN, Italy
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Abstract
Objectives: Yew plant materials contain highly toxic taxine alkaloids. Serious ingestions can result in life-threatening toxicity. The purpose of this article is to summarize the literature on the treatment of acute yew poisoning. Data Sources: PubMed (January 1946 to November 2017) was searched using the search terms “taxus/po”. EMBASE (1980 to November 2017) was searched using the search terms “taxus/to” and “yew.mp.” Web of Science (1945 to November 2017) was searched using the text words taxus, taxine, and yew. Study Selection and Data Extraction: Available English language articles involving case reports, epidemiology, treatment, and outcomes were included. Data Synthesis: Although not uncommon, unintentional yew poisoning rarely results in significant morbidity or mortality. A total of 26 case reports of yew poisoning were evaluated along with 4 case series articles (totaling 22 additional cases). Only 4 of the 48 total cases (8%) were accidental poisonings, the rest being deliberate ingestions. In 20 patients (42%), it resulted in fatalities. Severe, acute yew poisoning results in symptomatology largely resistant to pharmacotherapy intervention. Conclusions: Most nonintentional ingestions of yew plant constituents are asymptomatic and require little intervention. Severe poisoning can result in life-threatening cardiac toxicity and require aggressive supportive care. Therapeutic interventions, such as sodium bicarbonate, digoxin immune fab, and hemodialysis that have been utilized in case studies and case series in the literature have little proven benefit. Extracorporeal life support should be considered in severe yew poisoning.
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Affiliation(s)
| | - Dennis F. Thompson
- Southwestern Oklahoma State University, College of Pharmacy, Weatherford, OK, USA
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Dela Cruz M, McCloskey K, Mostafa A, Ershad M, McKeever R, Vearrier D. Cardiotoxicity resulting from yew plant ( Taxus canadensis) ingestion. TOXICOLOGY COMMUNICATIONS 2018. [DOI: 10.1080/24734306.2018.1532677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Maricel Dela Cruz
- Division of Medical Toxicology, Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Kristen McCloskey
- Division of Medical Toxicology, Department of Emergency Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Ahmed Mostafa
- Division of Medical Toxicology, Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Muhammed Ershad
- Division of Medical Toxicology, Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Rita McKeever
- Division of Medical Toxicology, Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - David Vearrier
- Division of Medical Toxicology, Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
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ECG of a "dying heart" in a young woman--a case of yew poisoning. Int J Cardiol 2013; 167:e71-3. [PMID: 23602296 DOI: 10.1016/j.ijcard.2013.03.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 03/30/2013] [Indexed: 11/20/2022]
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A fatal case of Taxus poisoning. CLUJUL MEDICAL (1957) 2013; 86:279-81. [PMID: 26527962 PMCID: PMC4462509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 08/22/2013] [Accepted: 09/02/2013] [Indexed: 10/27/2022]
Abstract
CONTEXT Taxine-derived alkaloids, taxane-derived substances, and glycosides seem to be responsible for the toxicity of Taxus spp. by blocking microtubule, sodium and calcium channels causing conduction abnormalities. Cases with Taxus baccata acute intoxication have rarely been reported. CASE DETAILS We report the case of a 43-year-old man who ingested, for suicidal purposes, common (or European) yew leaves (Taxus baccata) and presented severe hypokalemia, ventricular arrhythmias with hemodynamic instability accompanied by severe multiple organ dysfunction syndrome, including respiratory insufficiency, renal failure, acid-base imbalance with severe hypokalemia, hepatic dysfunction and coma, which led to death 12 hours after Taxus baccata ingestion. CONCLUSION In this particular case, the cardiac electrical instability was definitely maintained by several causes, including severe hypokalemia, which has not been previously reported as related to Taxus poisoning. The metabolic acidosis associated with severe hypokalemia definitely contributed to the complex arrhythmias. The occurrence of severe hypokalemia needs further attention in cases with Taxus poisoning as its immediate treatment might increase survival chances.
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Panzeri C, Bacis G, Ferri F, Rinaldi G, Persico A, Uberti F, Restani P. Extracorporeal life support in a severe Taxus baccata poisoning. Clin Toxicol (Phila) 2010; 48:463-5. [DOI: 10.3109/15563650.2010.487487] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kawohl W, Eckert J, Gerber-Zupan G, Habermeyer E. [Psychiatric aspects of plant poisonings]. DER NERVENARZT 2005; 76:875-6, 877-8. [PMID: 15856152 DOI: 10.1007/s00115-005-1912-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Plant poisonings have been reported since ancient times. Despite this, little attention is paid to intoxications with herbal poisons by psychiatric literature and the danger from poisonous plants is commonly underestimated. This problem is discussed here, and advice for the prevention of plant poisonings and generally dealing with patients intoxicated by herbal poisons is given.
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Affiliation(s)
- W Kawohl
- Psychiatrische Universitätsklinik Zürich, Schweiz.
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Graeme KA, Ruha AM, Tanen DA, Curry SC, Miller MB, Gerkin R, Reagan CG, Brandon TA. Hypertonic Sodium Bicarbonate for Taxus media-induced Cardiac Toxicity in Swine. Acad Emerg Med 2002. [DOI: 10.1197/aemj.9.3.179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Affiliation(s)
- M. R. Lee
- 112 Polwarth Terrace, Edinburgh EH11 1NN
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