Yew tree poisoning: a near-fatal lesson from history (1)
Editor - We read with interest and concern Jones et al's case report of yew tree poisoning in which they appear to advise induced emesis in the management of overdose (Clin Med April 2011 pp 173–5), a therapy not advised by the UK National Poisons Information Service (NPIS) for over 20 years. While syrup of ipecac was used historically in management of poisoned patients, the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists published a position statement in 2004 no longer recommending routine administration of syrup of ipecac in poisoned patients.1 This was as a result of limited evidence for improved outcome following its use in clinical studies, together with a significant risk of aspiration particularly in those with reduced consciousness. Equally importantly administration of syrup of ipecac may delay administration or reduce effectiveness of activated charcoal, the gastric decontamination agent of choice.
Yews (Taxus spp., Taxaceae) are poisonous evergreen shrubs common throughout the UK. Toxicity is primarily related to the cardiotoxicity of taxine alkaloids, present in all plant parts except the scarlet aril (berry).2 Management of yew poisoning is largely supportive as no antidote exists. We would remind readers that TOXBASE®, the online database of the NPIS, carries current advice on best practice in poisons management.3 After charcoal, further management includes fluid resuscitation, monitoring of cardiac rhythm and, in severe cases, inotropic support and cardiac pacing. Use of digoxin-specific FAB antibody fragments has been proposed on account of structural similarity between digitalis and the taxine molecule.4 NPIS advice on TOXBASE reflects this publication but stresses that there is no information available to guide dosing.
This case report describes a rare cause of poisoning in the UK but highlights the wider issue of gastric decontamination in poisoned patients, and that use of syrup of ipecac has now become obsolete. We strongly recommend that your readers obtain up-to-date advice from NPIS when managing rare poisons.
Footnotes
Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk
- © 2011 Royal College of Physicians
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