Transcript CPC Case Submission “The Case of the Cardiac Casserole”

The Case of the
Cardiac Casserole
Conclusion
“The Case of the Cardiac Casserole”
Solution
Ramp
• Allium tricoccum, wild leek,
AKA “ramp”
• Family: Liliaceae (Lily)
• Habitat: Damp woodlands
of eastern US
• Description: Bulbs produce
2-3 smooth, ovate leaves,
that grow to 8-12” tall and
2” wide
Allium tricoccum
• “…the sweetest tasting and
vilest smelling vegetable in
Mother Nature’s bounty.”
• Called “ramptzes”
• First Ramp Festival occurred
in Cocke County, TN
First Ramp Festival, April 1954
• Enjoyed Activities
Combination Recipe: "I’ve Won the Lottery” Soup
Cream of Ramps and Nettle Soup (4 servings)
-2 Knoors vegetarian bullion cubes, dissolve in a quart of water
-4 cups wild leek leaves (Ramps)
-4 or 5 wild leek bulbs
-4 pounds of stinging nettle leaves
-1 cup low fat sour cream
-1/4 cup of pastina
- 4 cups water
And the answer is…
False Hellebore
• Veratrum viride, AKA False
Hellebore
• Family: Liliaceae (Lily)
• Habitat: moist woodlands in
Canada and eastern US
• Description: Tall perennial
herb, 4-6 feet high with
alternate, broad, pleated leaves
Veratrum viride
“The Case of the Cardiac Casserole”
• Mature Veratrum does not resemble ramp…
• However, in early spring, the shoots of young
plants can look similar…
Veratrum viride
Allium tricoccum
“The Case of the Cardiac Casserole”
Folly while Foraging
“The Case of the Cardiac Casserole”
Folly while Foraging
False Hellebore Ingestion
Signs/Symptoms:
• GI: mucous membrane irritation,
nausea, vomiting, diarrhea,
abdominal pain
• CV: bradycardia, hypotension
• Resp: deceased respiration
• CNS: confusion, seizure
• Neuromuscular: cramps,
paresthesias, increased muscle tone
Veratrum viride
Veratridine
 Stimulates vagal fibers
hypotension and bradycardia
 Increases permeability of voltage-sensitive fast
channels in myocytes
muscular cramps and weakness
potential for ventricular dysrhythmia
 Does not inhibit Na-K ATPase
Veratridine
• Structurally dissimilar to
cardiac glycosides
• Signs/symptoms
indistinguishable from plant
ingestion containing cardiac
glycosides
Veratridine
Digoxin
Treatment
•
•
•
•
•
•
•
Supportive care
Consider GI decontamination
Fluid Replacement
Electrolyte Correction
Antiemetic
Bradycardia: atropine
Hypotension: IVF, vasopressor support
Case Conclusion
• Both admitted to the ICU
• No further bradycardia or hypotension
• Digoxin Fab fragments were considered but
not given
• Both patients had good outcome