Clinical Toxicology of Yew Poisoning

Labossiere, Alexander W; Thompson, Dennis F.

doi:10.1177/1060028017754225

Cited by 17 publications

(17 citation statements)

References 49 publications

(81 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Along with gastroscopy and charcoal administration, multiple measures are used to limit the toxicity of T. baccata. 2 A particular problem is the poor response of associated arrhythmias and cardiogenic shock to atropine, 5,13 external/internal pacing 14,15 or catecholamines, 5,7,13 intravenous administration of lidocaine, 16 and sodium bicarbonate 17,18 . Few case reports attribute beneficial effects to digoxin‐specific antibodies (fab fragment) 5,19 .…”

Section: Discussionmentioning

confidence: 99%

“…T. baccata poisoning is observed after accidental ingestion or attempted suicide. Clinical symptoms are caused by the blockade of cellular sodium and calcium channels and range from mild gastrointestinal symptoms to seizures, cardiac dysrhythmias, and cardiogenic shock 1,2 . Confirmation of Taxine B, 3,5‐dimethoxyphenol (3,5‐DMP), or other taxines in the blood serve as markers of ingestion 3 …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Extracorporeal life support as bridge to recovery in yew poisoning: case reports and literature review

et al. 2020

View full text Add to dashboard Cite

Aims This short communication aims to review the treatment of cardiogenic shock in patients with yew poisoning based on two case reports from our institution, focusing on the use of extracorporeal life support (ECLS). Methods and results We report two cases of Taxus baccata poisoning treated with ECLS at our institution and review the literature based on a search in PubMed and Google Scholar on the topic of yew poisoning and ECLS. All cases were combined for analysis of demographics, ECLS therapy, and outcome. Case 1: A 35‐year‐old woman developed polymorphic ventricular tachycardia followed by cardiovascular arrest 5 h after orally ingesting a handful of yew needles. Successful resuscitation required ECLS for 72 h due to ongoing cardiac arrhythmias and cardiogenic shock. The patient left the hospital without neurological sequelae after 10 days. Case 2: A 30‐year‐old woman developed refractory cardiac arrhythmias and circulatory arrest. Resuscitation included ECLS for 71 h. T. baccata needles found by gastroscopy confirmed the diagnosis. The patient had no neurologic deficits and was transferred to psychiatry after 11 days. Review of the literature: Nine case reports were found and analysed along with our two cases. Five out of the 11 (45%) patients were female. Median (range) age was 28 (19–46) years. T. baccata needles were ingested with a suicidal intention in all patients. Median (range) duration of ECLS was 70 h (24–120 h). Eight (73%) patients had full neurological recovery. Conclusions Yew poisoning is a differential diagnosis in young psychiatric patients presenting with polymorphic ventricular tachycardia and cardiogenic shock. A characteristic cardiac contraction pattern in echocardiography may present a diagnostic clue. The early use of ECLS is a valuable bridge to recovery in most of these patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Extracorporeal life support as bridge to recovery in yew poisoning: case reports and literature review

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Mechanical cardiac support like extracorporeal membrane oxygenation may be considered if other measures have failed. Diagnosis of taxine poisoning in livestock after accidental feedings of yew bush clippings has been contingent on history of exposure and identification of yew in the digestive tract [7]. Due to their prolonged gastric transit time, yew leaf recovery from the stomach may reduce taxine absorption 3 .Our discovery of needlelike green objects consistent with the leaves of Taxus baccata in postmortem gastric contents (Figure 2) is the first reported instance of yew identification in the gastrointestinal tract of a human victim [6].…”

Section: Discussionmentioning

confidence: 98%

Statement of Removal

Nellore

Pfeifer

et al. 2021

Toxicology Communications

View full text Add to dashboard Cite

Taxus baccata (yew) is an easily accessible plant that can cause rapidly fatal cardiotoxicity upon ingestion. While it has been documented as both a method of suicide and homicide, such cases may be underreported due to the difficulty of recognition. toxicity of the yew is due to the alkaloids taxine a and taxine B, both of which form 3,5-dimethoxyphenol metabolite. Neither alkaloids nor the metabolite is detected by routine drug screening.Here, we present a case of suicide by yew ingestion. 3,5-dimethoxyphenol was detected in gastric contents, postmortem blood and urine by two mass spectrophotometric techniques including high resolution mass spectrometry. the gastric contents contained a green, needlelike substance consistent with the yew plant. Utilizing broad spectrum screening by mass spectrometry along with comprehensive history may result in early detection of yew toxicity, facilitate treatment of cardiotoxicity, and improve survival.

show abstract

“…The reports described clinical manifestations similar to those observed with digoxin toxicity, including bradycardia, atrioventricular block, nausea, vomiting, abdominal pain, and hyperkalemia. Literature reports have described successful use of digoxin immune fab in managing non-digoxin cardiac glycoside poisonings with oleander leaves [24], toad venom [25], and some Chinese herbal supplements [26,27]; others have reported unfavorable outcomes, including in cases of severe yew poisoning [28,29]. b DigiFab administered following ingestion of Almendra quema grasa (n = 1), Cerbera odollam seeds (n = 3), Convallaria majalis (n = 1), Crataegus mexcicana (n = 1), Taxus baccata (English yew or European yew) (n = 2), Jamaican stone (n = 1), oleander leaves (n = 1), Piedra China (n = 1), or toad head (n = 1) An important strength of our study is the national representation of AEs reported for DigiBind and DigiFab in the real-world setting, during a postmarketing study period of more than 30 years.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Adverse Events Associated with Use of Digoxin Immune Fab Reported to the US Food and Drug Administration Adverse Event Reporting System, 1986–2019

Wei

Niu

Dores

2021

Drugs - Real World Outcomes

View full text Add to dashboard Cite

Background Digoxin immune fab products, DigiBind and DigiFab, are antidotes for the treatment of patients with lifethreatening or potentially life-threatening digoxin toxicity or overdose. Although approved by the US Food and Drug Administration (FDA) in 1986 (DigiBind) and 2001 (DigiFab), there remains a paucity of literature describing the safety of these products in the postmarketing setting. Objective We sought to assess US adverse event (AE) reports submitted to the FDA Adverse Event Reporting System (FAERS) for DigiBind and DigiFab in the postmarketing period. Patients and Methods We searched reports for DigiBind and DigiFab submitted from the time of each product approval through December 31, 2019. Descriptive statistics were used to assess AE reports for DigiBind and DigiFab. Empirical Bayes geometric means (EBGMs) and their 90% confidence intervals were computed to identify disproportionate (i.e., at least twice the expected) reporting of DigiBind and DigiFab. Reports describing selected AEs and death outcomes were individually reviewed. Results A total of 78 DigiBind and 43 DigiFab reports were identified, of which 68 DigiBind (87.2%) and 27 DigiFab (62.8%) reports were serious. Among the most frequently reported AEs for both products [DigiBind, DigiFab, respectively] were cardiac (bradycardia [3.8%, 3.9%], cardiac arrest [3.3%, 3.9%], and hypotension [2.4%, 2.6%]) and non-cardiac (nausea [1.9%, 2.6%] and hyperkalemia [1.4%, 1.9%]) events. These AEs were labeled events or confounded by indication for use (digoxin toxicity). Nineteen (24.4%) DigiBind and 13 (30.2%) DigiFab reports described an outcome of death, of which seven (53.8%) DigiFab reports were attributed to poisoning with non-digoxin cardiac glycosides. No deaths could be attributed to DigiBind or DigiFab administration. Conclusions Our analysis did not identify new safety concerns for DigiBind or DigiFab. Most AEs reported were labeled events or confounded by indication for use.

show abstract

Clinical Toxicology of Yew Poisoning

Cited by 17 publications

References 49 publications

Extracorporeal life support as bridge to recovery in yew poisoning: case reports and literature review

Extracorporeal life support as bridge to recovery in yew poisoning: case reports and literature review

Statement of Removal

Adverse Events Associated with Use of Digoxin Immune Fab Reported to the US Food and Drug Administration Adverse Event Reporting System, 1986–2019

Contact Info

Product

Resources

About