Acute Yew-Intoxication (Taxus baccata): Lessons to Be Learned for Pediatric Cardiologists

Background: The yew-intoxication is a heavy poisoning by the alkaloid Taxin B; it presents as severe, refractory cardiac arrhythmias with a widely varying picture. We present two different cases of acute yew intoxication with a colorful picture of malignant arrhythmias.

Methods: The first case, a 16-year-old boy prepared a fruit and leaves smoothie to change his eating habits and reduce weight; a few hours later, nausea, vomiting and severe dizziness occurred. The emergency ambulance team diagnosed a resistant VT (HR of 180/min) despite 450 mg amiodarone, a short period of resuscitation and three trials of cardioversion. Here, the patient required repetitive CPR, with heartrates from 45/min to 150, and ongoing VT. Amiodarone infusion resulted in severe bradycardias (27/min) with sustained VT. Fruit identification was possible by the patients’ mobile phone and treatment with digoxin-specific Fab antibody fragments was initiated. Thereafter the rhythm quickly stabilized. The second case, a 16-year-old boy, presented with a tonic-clonic seizure and a cardiac arrest. The ambulance team diagnosed under CPR first polymorphic then monomorphic VT, which persisted despite 300 mg amiodarone, 2 g Magnesium and six cardioversions. On admission there was ongoing broad complex VT (QRS 180 milliseconds, HR 24–68/min) and repetitive CPR. Intoxication was presumed, lipid resuscitation was initiated with no clear effect. Severe brady-arrhythmia required repetitive adrenaline boluses, an intracardiac pacemaker was placed without any capturing. Gastroscopy showed many green leaves, identified as Taxus baccata that were removed. Gastric charcoal was administered. Thereafter, the ECG normalized quickly within 12 hours.

Results: These colorful pictures of refractory VT with many different QRS vectors, torsades and strongly variable heart rate, which responded neither to electrical therapy nor to any drug interventions, ultimately manifested as an acute yew-intoxication. This intoxication is a rare, but often severe. The rapid identification of the intoxication is crucial to enable poison removal, unspecific measures and a targeted therapy (digoxin-specific Fab antibody fragments); in unclear similar cases, the administration of the antibody appears to be an elegant approach.

Conclusion: Unfortunately the frequency of these cases increase in attempted suicide situations; therefore, this special clinical picture should be reminded to those working in emergency medicine.

Publication History

Article published online:
13 February 2024