Treat the patient by the recognized toxidrome when the ingested herbal juice is non-toxic

Abstract

This is the case of 63-year-old mother and her 35-year-old daughter who drank herbal juice (Rhizoma Dioscoreae Nipponicae and Ficus formosana Maxim) and then developed diarrhea, cold sweating, and myoclonus. On physical examination, the mother had a normal consciousness level, a normal respiratory rate, and bilateral miosis. After the administration of 2 g of pralidoxime (PAM) and 0.5 mg of atropine, the mother felt better. The daughter only had mild symptoms of sweating and vomiting before arrival at the emergency department (ED).The poison center of our hospital was consulted, and they assured us that the herbs ingested were all non-toxic. In conclusion, the majority of emergency physicians are not familiar with herbal medicines and plants. In this instance, however, it was more important to apply appropriate early management according to the toxidrome rather than to recognize what kind of herb had been ingested.