Treatment for Pokeweed Poisoning
Pokeweed poisoning should be managed with supportive care only, focusing on gastrointestinal decontamination in early presentations and symptomatic treatment, as there is no specific antidote and activated charcoal or other home remedies should not be administered.
Immediate Management
First Aid and Poison Control
- 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 1
- Contact the Poison Help hotline immediately (1-800-222-1222 in the US) for expert guidance, as board-certified toxicologists can provide specialized treatment recommendations 2
- If the patient exhibits signs of a life-threatening condition (severe vomiting, cardiac symptoms, altered mental status), activate emergency medical services immediately 1, 2
Decontamination Considerations
- Gastrointestinal decontamination (gastric lavage) may be considered only in selected patients presenting within 1-2 hours after acute ingestion, though evidence is limited 1
- Remove any contaminated clothing if plant material contacted skin 3
Hospital-Based Supportive Care
Gastrointestinal Management
- The primary toxicity of pokeweed is severe gastroenteritis with intense vomiting and frothy diarrhea, which is typically self-limited 4
- Provide aggressive fluid resuscitation for dehydration secondary to vomiting and diarrhea 5
- Antiemetics may be administered to control severe vomiting 4
Cardiovascular Monitoring
- Continuous cardiac monitoring is essential, as pokeweed can cause cardiac conduction abnormalities including Mobitz type I heart block 4
- The cardiac effects may be secondary to increased vagal tone from severe gastrointestinal distress rather than direct cardiotoxicity 4
- Use vasopressors if hypotension persists despite adequate fluid resuscitation 1
Neurological Assessment
- Monitor for cholinergic symptoms including sweating, confusion, tremor, weakness, and altered mental status, as pokeweed contains agents that produce peripheral and central cholinergic stimulation 6
- Provide airway management and mechanical ventilation if respiratory depression develops 1
- Atropine may be considered for severe cholinergic symptoms, though this is based on the symptom profile rather than established protocol 6
Toxin Identification
- The toxic compounds in pokeweed are triterpenoid saponins (phytolaccosides and esculentosides) present in all parts of the plant, with roots being most toxic 7
- Laboratory confirmation via LC-MS/MS can detect esculentosides A, B, C, and H in blood, urine, and gastric contents, though this is primarily for forensic purposes rather than acute management 7