Cicutoxin

Cicutoxin is a highly potent natural toxin produced by certain water hemlock plants in the genus Cicuta, especially Cicuta maculata (water hemlock) and Cicuta virosa (European water hemlock). It is a lipophilic, highly unsaturated organic compound that acts as a convulsant in the central nervous system. Cicutoxin is believed to cause toxicity by antagonizing inhibitory GABA neurotransmission, leading to unregulated neuronal firing and seizures.

The onset of symptoms after ingestion is typically rapid, ranging from 30 minutes to several hours. Early signs may include nausea, vomiting, and abdominal pain, followed by neurological symptoms such as tremors, myoclonic movements, generalized seizures, coma, and potentially respiratory failure. Poisoning can be rapidly fatal, particularly in children, due to prolonged seizures and secondary complications such as aspiration.

Diagnosis relies on compatible exposure history and clinical presentation; plant identification supports the diagnosis. Toxicology tests for cicutoxin exist in some laboratories but are not routinely available in many clinical settings.

There is no specific antidote for cicutoxin poisoning. Management is supportive and urgent: secure the airway and provide respiratory and circulatory support as needed. Seizures are treated with benzodiazepines, and more aggressive anticonvulsants or anesthetic therapy may be required in refractory cases. Decontamination with activated charcoal may be considered if the patient presents soon after ingestion.

Public health considerations emphasize prevention, particularly avoiding ingestion of wild plants and ensuring proper identification, especially around children. Education and cautious foraging practices are important to reduce accidental poisonings.