IM22.2-3 | Plant and Corrosive Poisoning — Summary & Reflection

KEY TAKEAWAYS

Plant poisoning in India — key agents:
- Datura stramonium: anticholinergic toxidrome (mydriasis, dry flushed skin, delirium, tachycardia, hyperthermia, urinary retention); no specific antidote; physostigmine for severe cases; full recovery usual
- Yellow/common oleander (Thevetia/Nerium): cardiac glycoside poisoning (nausea, bradycardia, AV block, ventricular arrhythmias, hyperkalaemia); antidote = digoxin-specific Fab fragments; serum K > 5.5 mEq/L = high mortality
- Aconite (Vatsanabha): paraesthesiae → paralysis → ventricular arrhythmias (Nav channel activation); no antidote; antiarrhythmics + pacing + ventilation
- Cleistanthus collinus: mitochondrial toxin → hypokalaemia + metabolic acidosis + paralysis + AKI; no antidote; K replacement + dialysis + ventilation

Corrosive poisoning:
- Acid: coagulative necrosis; stomach > oesophagus; acute gastric perforation + delayed pyloric stenosis
- Alkali: liquefactive necrosis; oesophagus > stomach; airway emergency + oesophageal stricture
- Management: NEVER induce emesis, NEVER give charcoal, NEVER neutralise, NEVER pass NGT blindly; secure airway first (intubate for stridor/hoarseness); IV analgesia; NPO; endoscopy at 12–48 hours (Zargar grading); surgical referral for perforation; long-term surveillance for stricture and carcinoma

REFLECT

Consider the two patients from the opening hook. The woman with Datura poisoning from a traditional healer's preparation — what systemic and cultural factors led to her exposure, and how would you address her ongoing mental health needs once she recovers? Now consider the man who drank corrosive fluid at the construction site — was this deliberate or accidental? How do you approach the medico-legal documentation, and what follow-up does he need for oesophageal stricture surveillance? Beyond the clinical, these cases raise questions about access to traditional medicine regulation, occupational chemical safety, and suicide prevention in vulnerable populations. How does the physician's role extend beyond the emergency department into these broader domains? Reflecting on these questions prepares you for the social medicine dimensions of IM22.2 and IM22.3 that written examinations rarely test but that every practising physician navigates.