A Case Report of Water Hemlock Poisoning

Abstract

Introduction: Water hemlock poisoning is an uncommon cause of seizures, gastrointestinal upset, and renal failure. This poisoning occurs infrequency and is likely to go unrecognized without a proper history and consideration in the differential diagnosis. Clinical Findings: A 23-year-old male with an unremarkable past medical history presented to the emergency department after being found unresponsive at a farm where he was employed. He had several tonic-clonic seizures en route. Initial evaluation was unremarkable and included toxicology screening, lumbar puncture, and brain imaging. Main diagnoses, therapeutics, interventions, and outcomes: The patient was treated with broad-spectrum antibiotics and antivirals with a suspected diagnosis of viral encephalitis. Over the next several days of hospitalization, he developed severe rhabdomyolysis and renal failure, and dialysis was anticipated. Upon further investigation, it was discovered that on the morning of his presentation, the patient made himself tea with a plant he had dug up while fly fishing. He believed the plant was valerian root after researching it on the Internet. The plant was later identified as water hemlock. With supportive care, the patient’s mentation cleared, and his renal failure spontaneously resolved without the need for dialysis. His symptoms fully resolved, and he was discharged home. Conclusions: This case illustrates an unusual etiology of seizures and rhabdomyolysis and the need for careful history taking. The interest in nontraditional medicine and the ease of finding amateur foraging data on the internet have greatly raised the possibility of accidental toxic ingestions.