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A Dangerous Cup of Tea

Published:January 13, 2014DOI:https://doi.org/10.1016/j.wem.2013.11.002

      Case Presentation

      A 24-year-old woman presented to the Emergency Department with palpitations and watery emesis 2 hours after ingesting a cup of tea. The tea had been brewed from dried flowers that had been picked in a mountainous area of southern California. She had previously dissolved the flowers in oil and applied them topically to resolve bruises. She ingested the flowers in tea in an attempt to relieve postoperative pain after a cesarean section. She had no other medical problems, had no known allergies, and took no other medications or herbal supplements. Physical examination was notable for pulse in the 120s, epigastric tenderness, and multiple episodes of nonbloody, nonbilious emesis. Electrocardiogram showed sinus tachycardia. Complete blood cell count, chemistry, and coagulation panel were normal. What was the cause of her symptoms?

      Diagnosis and Treatment

      Arnica toxicity. Arnica (Figure), a genus in the sunflower family that grows in temperate areas of the western United States, is the homeopathic remedy most frequently studied in clinical trials.
      • Ernst E.
      • Pittler M.H.
      Efficacy of homeopathic arnica: a systematic review of placebo-controlled clinical trials.
      When used topically, it is believed by homeopaths to resolve bruises and reduce muscle soreness. However, a review of placebo-controlled clinical trials found no data to support its efficacy.
      • Ernst E.
      • Pittler M.H.
      Efficacy of homeopathic arnica: a systematic review of placebo-controlled clinical trials.
      • Knuesel O.
      • Weber M.
      • Suter A.
      Arnica montana gel in osteoarthritis of the knee: an open, multicenter clinical trial.
      Components of the plant have immunomodulatory and cytotoxic effects.
      Final report on the safety assessment of Arnica montana extract and Arnica montana.
      Helenalin, a toxin in Arnica, inhibits platelet aggregation.
      Final report on the safety assessment of Arnica montana extract and Arnica montana.
      When ingested orally, Arnica may result in tachyarrhythmia, respiratory distress, gastrointestinal hemorrhage, muscle weakness, or death.
      • MacKinnon S.
      Arnica montana.
      There is no antidote to Arnica toxicity and treatment is supportive.
      Our patient received intravenous fluids and antiemetics. She was observed in the Emergency Department until her symptoms resolved and vital signs normalized.

      References

        • Ernst E.
        • Pittler M.H.
        Efficacy of homeopathic arnica: a systematic review of placebo-controlled clinical trials.
        Arch Surg. 1998; 133: 1187-1190
        • Knuesel O.
        • Weber M.
        • Suter A.
        Arnica montana gel in osteoarthritis of the knee: an open, multicenter clinical trial.
        Adv Ther. 2002; 19: 209-218
      1. Final report on the safety assessment of Arnica montana extract and Arnica montana.
        Int J Toxicol. 2001; 20 ([No authors listed].): 1-11
        • MacKinnon S.
        Arnica montana.
        Can Pharm J. 1992; 125 (128): 125-126
      2. Auerbach P.S. Wilderness Medicine. 6th ed. Elsevier, Philadelphia, PA2011