Yew poisoning – pathophysiology, clinical picture, management and perspective of fat emulsion utilization

Abstract

Plants of the Taxus genus, including common yew (T. baccata) that predominates in Europe, have been known for ages for their toxic properties. Particularly high concentrations of toxic pseudoalkaloids are present in the needles of this evergreen and highly popular decorative plant. Toxic substances are also found in the other plant parts, except for an aril, and their ingestion may be life-threatening. The literature published in the last decade includes many case reports describing yew poisoning. The statistical data indicate that most cases are incidental and mainly regard children attracted by red arils. According to the data provided by one of the Czech centres of toxicology and covering the years 2005-2014, children < 3 years of age constitute 45% to 75% of all patients consulted due to yew poisoning [1]. The most severe cases are suicidal attempts associated with the ingestion of high amounts of yew needles; they often concern young individuals and can be lethal in some cases. The information on various methods of committing suicide are easily available on the Internet. There are numer

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

“…Few case reports attribute beneficial effects to digoxin‐specific antibodies (fab fragment) 5,19 . Because taxines are lipophilic compounds, intravenous lipid emulsion (ILE) may be considered for their removal 20,21 . Noticeably, the use of ILE by itself has been associated with severe side effects: acute kidney and lung injury, venous thromboembolism, hypersensitivity, and fat overload syndrome have been described 22 .…”

“…5, 19 Because taxines are lipophilic compounds, intravenous lipid emulsion (ILE) may be considered for their removal. 20,21 Noticeably, ECLS in yew (Taxus baccata) poisoning the use of ILE by itself has been associated with severe side effects: acute kidney and lung injury, venous thromboembolism, hypersensitivity, and fat overload syndrome have been described. 22 Caution is advised if ILE is to be used in a patient on ECLS because blood clot formation in the circuit and malfunction of the membrane oxygenator due to fat emulsion agglutinations have been reported.…”

Cardiogenic shock due to yew poisoning rescued by VA-ECMO: case report and literature review

“…A literature search on PubMed using the mesh-terms ECMO AND (taxine OR yew OR taxus) revealed a handful of other case reports published involving patients which were resuscitated using VA-ECMO after intentional ingestion of yew leaves and branches leading to cardiogenic shock [ 3–10 ]. Additional therapeutic approaches included albumin dialysis, digoxin immune Fab, and lipid-emulsion therapy [ 8 , 10 , 12 , 13 ]. However, these approaches are not feasible in patients undergoing cardiopulmonary resuscitation.…”

Pica (Allotriophagy): An Underestimated Risk Factor for Severe Leptospirosis (Weil’s Diseases)? Report of a Leptospira Septic Shock Successfully Managed with ECMO

“…When related to leptospirosis, cardiac involvement in the form of ECG changes (e.g., non-specific conduction system abnormalities, arrhythmias, alterations similar to acute pericarditis, T-wave inversions, S-T segment elevations), and myocarditis can occur as early as the leptospiremic phase; this is probably secondary to toxin-mediated vascular damage, leading to intimitis and perivascular and subendocardial inflammation [ 14 ]. The cardiotoxic effects of yew generally develop 1–3 days after yew ingestion [ 15 ], and are primarily related to the presence of taxine alkaloids (mainly taxine B, associated with its calcium channel antagonism and early sodium current inhibition effects), which have a strong toxic effect on the heart by depressing myocardial contractility and increasing atrio-ventricular conduction time, resulting in the widening of QRS complexes, II/III degree atrio-ventricular blocks and, ultimately, cardiac arrest [ 15 , 16 ]. In the reported case, both causes may have played a role in determining the cardiac complications.…”