Table 3 Useful steps in managing patients with toxicities from dietary supplements or herbal medicines
From: Dietary supplements and herbal medicine toxicities—when to anticipate them and how to manage them
1. Ask specifically regarding use of such products | |
2. Secure sample for identification | |
a. Actual herbs or product used | |
b. Prescription or packaging | |
3. Laboratory studies | |
a. Basic blood count, renal function, liver function, and electrocardiogram | |
b. Heavy metal screening if suspected or if symptoms are non-specific | |
c. Analysis methods exist for some herbal toxins only—colchicines (HPLC, GCMS), tropane alkaloids (GCMS, oxalate (GCMS), vinca alkaloids (HPLC), cardioactive steroids (immunoassay)—check with local laboratory | |
4. Good resuscitative, symptomatic, and supportive care | |
5. Use antidote if appropriate | |
6. Instruct patients and family to stop using the product | |
7. Consider outpatient monitoring of renal function, liver function, and blood counts | |
8. Report case to regulating authority | |
9. Report unusual cases in the medical literature | |