title: Prolonged ventilatory failure and flaccid quadriparesis after ingestion of poison hemlock.
abstract: BACKGROUND
  A 28-year-old man presented with acute flaccid paralysis and respiratory failure that persisted for 2 weeks after suicidal ingestion of unknown substances.
  
  
  METHODS
  Extensive clinical, nerve, laboratory, and neuroimaging testing excluded alternative causes of this neuromuscular syndrome. Prompted by clues provided by family members, liquid chromatography time-of-flight mass spectrometry was used to investigate for the presence of poison hemlock.
  
  
  RESULTS
  Testing of the residue in a jar used for the ingestion of a poisonous concoction confirmed the presence of the nicotinic alkaloid coniine. Analysis of patient serum suggested the presence of conhydrine. Concentrations of amitriptyline and diazepam were also found to be supratherapeutic, but only through the first few days of hospitalization.
  
  
  CONCLUSIONS
  Herein we describe a case of reversible coma, flaccid quadriparesis, and neuromuscular respiratory failure caused by intentional ingestion of poison hemlock.
authors.affiliation: Department of Emergency Medicine, University of California, San Francisco, 1001 Potrero Avenue, Room 1E21, San Francisco, California, 94110, USA.
authors.forename: Derrick D
authors.initials: DD
authors.lastname: Lung
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Scott
authors.forename: Alan H B
authors.initials: AH
authors.lastname: Wu
authors.forename: Roy R
authors.initials: RR
authors.lastname: Gerona
mesh_terms: D000328:Adult; D003128:Coma / Q000139:chemically induced*; D029982:Conium / Q000737:chemistry / Q000506:poisoning*; D004435:Eating / Q000502:physiology; D006801:Humans; D008297:Male; D010939:Plant Poisoning / Q000097:blood / Q000150:complications*; D011782:Quadriplegia / Q000139:chemically induced*; D012131:Respiratory Insufficiency / Q000139:chemically induced*; D013406:Suicide, Attempted
keywords: acute quadriparesis; coniine; hemlock; overdose; poisoning