Traditional Chinese medicine poisoning in the emergency departments in Hong Kong: Trend, clinical presentation and predictors for poor outcome

Rex Pui Kin Lam, Eric Ho Yin Lau, Wai Lam Yip, Joe Kai Shing Leung, Matthew Sik Hon Tsui

Table 2 The Poison Severity Score (PSS) and distribution of most severe symptomatology in different organ systems of ten selected toxic herbal ingredients

Herbal ingredients involved Median PSS (IQR) Organ system where the most severe symptomatology occurred Commonest clinical features (n, %) Intervention provided (n, %) Aconitine 2.0 (1.8-3.0) Cardiovascular system Limb numbness (13, 72.2), perioral numbness (12, 66.7), dizziness (12, 66.7), ventricular ectopics (7, 38.9), ventricular tachycardia (6, 33.3), vomiting (6, 33.3) IV fluid (12, 66.7), administration of amiodarone (7, 38.9), administration of magnesium (4, 22.2), use of inotrope (4, 22.2), intubation (3, 16.7), synchronized cardioversion (3, 16.7), defibrillation (2, 11.1), activated charcoal (2, 11.1), CPR (1, 5.6) Atropine/hyoscyamine/ scopolamine 1.0 (1.0-1.5) Nervous system Anticholinergic toxidrome (3, 100), dizziness (3, 100) IV fluid (1, 33.3) Cardiac glycosides 1.0 (1.0-2.5) Cardiovascular system Vomiting (3, 75.0), abdominal pain (2, 50.0), dizziness (2, 50.0), sinus bradycardia (1, 25.0) IV fluid (1, 25.0), activated charcoal (1, 25.0), administration of DigiFab (1, 25.0) Psoralen/isopsoralen 2.0 (2.0-2.5) Liver/kidney Tea-colour urine (8, 88.9), malaise (8, 88.9), jaundice (4, 44.4), peak ALT > 1,000 IU/L (4, 44.4), renal impairment (1, 11.1) IV fluid (1, 11.1), haemodialysis (1, 11.1) Sophora alkaloids 1.0 (1.0-1.0) Nervous system Dizziness (8, 88.9), vomiting (5, 55.6), palpitation (4, 44.4), limb weakness (3, 33.3), diarrhoea (3, 33.3) IV fluid (3, 33.3) Methyl salicylate 1.0 (0.3-3.0) Nervous system Dizziness (5, 31.3), vomiting (5, 31.3), abdominal pain (5, 31.3), decrease in sensorium (4, 25.0), metabolic acidosis (2, 12.5), hypokalaemia (2, 12.5) IV fluid (14, 87.5), activated charcoal (12, 75.0), urine alkalinization (5, 31.3), intubation (4, 25.0), haemodialysis (3, 18.8), gastric lavage (2, 12.5), defibrillation (1, 6.3), CPR (1, 6.3) Anthraquinones 2.0 (1.5-2.5) Liver/kidney Tea-colour urine (9, 69.2), peak ALT > 1,000 IU/L (8, 61.5), jaundice (7, 53.8), malaise (6, 46.2), poor oral intake (5, 38.5) IV fluid (1, 7.7)