What is the treatment for solanine poisoning from consuming rotting potatoes?

Treatment for Solanine Poisoning from Rotting Potatoes

There is no specific antidote for solanine poisoning; treatment is entirely supportive care focused on managing gastrointestinal, cardiovascular, and neurological symptoms as they arise. 1, 2

Immediate First Aid Management

• Do NOT administer activated charcoal, ipecac, milk, or water by mouth unless specifically directed by a poison control center, as there is insufficient evidence these interventions provide benefit and they may cause harm including emesis and aspiration 3
• Contact the Poison Help hotline immediately (1-800-222-1222 in the United States) for expert guidance on managing the specific case 3
• If the patient exhibits signs of a life-threatening condition (altered consciousness, seizures, difficulty breathing, vomiting, cardiovascular instability), activate emergency medical services immediately 3

Hospital-Based Supportive Care

Gastrointestinal Management

• Provide symptomatic treatment for vomiting, diarrhea, and abdominal pain, which are the primary manifestations of solanine toxicity 1, 4
• Gastrointestinal decontamination (gastric lavage) may be considered in selected patients presenting early after acute ingestion, though evidence is limited 3
• Monitor for gastrointestinal bleeding, as solanine can cause hemorrhage in the gut at higher doses 5

Cardiovascular Monitoring and Support

• Monitor for hypotension, rapid pulse, and cardiovascular complications, particularly in severe cases 1, 4
• Administer intravenous fluids for volume repletion and hypotension 1
• Use vasopressors if hypotension persists despite adequate fluid resuscitation 3

Neurological Assessment

• Assess and manage altered mental status, seizures, and other neurological disorders that can occur at higher solanine doses 1, 4, 6
• Provide airway management and mechanical ventilation if respiratory depression or failure develops 3

Additional Monitoring

• Monitor for fever, rapid respiration, and dermatological manifestations (exanthematous syndrome) 4, 2
• Obtain baseline laboratory studies including electrolytes, renal function, and complete blood count 1
• Pediatric patients may require intensive care unit admission for severe cases with cardiovascular or neurological complications 1

Clinical Pearls and Pitfalls

• Solanine poisoning is relatively rare despite widespread potato consumption, making diagnosis challenging and often based on history of consuming green, sprouted, or rotting potatoes and compatible clinical presentation 1, 6
• The toxic glycoalkaloid (alpha-solanine and alpha-chaconine) accumulates in green or sprouting potatoes, with concentrations increasing dramatically in damaged or improperly stored tubers 4, 5, 6
• Solanine is poorly absorbed orally and rapidly excreted, making it relatively less toxic than parenteral administration, but severe poisoning can still be fatal 2
• Most patients recover completely with conservative management and supportive care 1, 4
• The syndrome typically includes gastrointestinal disturbances first, followed by circulatory, neurological, and dermatological findings in more severe cases 4, 2