Extracorporeal life support in a severe Taxus baccata poisoning.
BACKGROUND
Yew (Taxus baccata) is a conifer known to be toxic since ancient times. Taxine A and taxine B, the toxic alkaloids of Taxus, block cardiac sodium and calcium channels causing nausea, vomiting, abdominal pain, cardiac arrhythmias, respiratory distress, coma, seizures, and death in yew poisoning.


METHODS
A 44-year-old male farmer was admitted to the hospital because of a suspected myocardial infarction. First bradycardia and then ventricular tachycardia were present and a severe right ventricular dilatation with biventricular dysfunction was observed but with normal coronary arteriography. He was resistant to conventional therapy and, 6 h after hospital admission, extracorporeal support with membrane oxygenation was applied. The patient recovered. Nine days later, a large number of yew leaves were unexpectedly observed in his feces. Botanical and laboratory analysis confirmed the poisoning. Blood (651 ng/mL) and urinary (5.6 mcg/mL) levels of 3,5-dimethoxyphenol (metabolite of taxicatine) were greater than previously reported in lethal cases. The patient was transferred to a psychiatric unit 17 days after admission.


CONCLUSIONS
Intensive treatment of severe cardiovascular symptoms with antiarrhythmic drugs, temporary pacemaker, intra-aortic balloon pump, extracorporeal membrane oxygenation, and extracorporeal life support can be life-saving even after a potentially lethal ingestion of T. baccata leaves.
Bergamo Poison Control Center, Ospedali Riuniti, Bergamo, Italy.
Claudia
C
Panzeri
Giuseppe
G
Bacis
Francesco
F
Ferri
Gabriele
G
Rinaldi
Andrea
A
Persico
Francesca
F
Uberti
Patrizia
P
Restani
D000328:Adult; D000470:Alkaloids / Q000506:poisoning*; D000889:Anti-Arrhythmia Agents / Q000506:poisoning; D001919:Bradycardia / Q000150:complications; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005517:Foodborne Diseases; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D010696:Phloroglucinol / Q000031:analogs & derivatives; D018515:Plant Leaves / Q000506:poisoning; D010939:Plant Poisoning / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D012640:Seizures / Q000150:complications; D017180:Tachycardia, Ventricular / Q000150:complications; D032490:Taxaceae; D043823:Taxoids; D020946:Taxus / Q000506:poisoning*
D000470:Alkaloids; D000889:Anti-Arrhythmia Agents; D043823:Taxoids; C047703:taxine; C015155:phloroglucinol dimethyl ether; D010696:Phloroglucinol