Tis the Season!


    Tis the Season!

    Its a holiday weekend. The decorations are up. Presents will soon be unwrapped. A beautiful tree is decorated and lit. But did you know your living room of festivity can be a death trap in the making? For example, the beautiful holly on the window sill, if ingested, has a toxin named saponin which can lead to nausea, vomiting, abdominal cramping and in more severe cases mydriasis, hyperthermia, and drowsiness. Likewise the mistletoe under which you had your first kiss has phoratoxin and viscotoxin which can lead to not only GI symptoms but also, in severe cases, to bradycardia, delirium, or liver/renal/CNS/adrenal gland toxicity with all the complications that can go with them. Even the fake snow which you’ve spread beneath your Christmas tree in easy reach of pets and crawling children can be made from an alkaline polymer which can lead to bronchospasm (watch those asthmatics) or ocular injury.

    Fortunately the treatment for all of these poisonings is supportive care, basic labs for some which can have end organ effects, and ekg. Very rarely are ingestions severe enough to warrant extended hospitalizations or ICU stays. Also inducing vomiting is not recommended as it does not seem to shorten duration or decrease severity of symptoms.

    Bottom Line: Don’t eat decorations. Don’t make people vomit. And enjoy the holiday weekend.


    Special thanks to Dr. Trevor Pour for the inspiration for this pearl.


    Salts, Lalia, and Francis Counselman. “Holiday Poisonings.” Emergency Medicine, vol. 48, no. 12, Jan. 2016, pp. 538–546., doi:10.12788/emed.2016.0071.

    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • renal handling of water

      If you were on a tea & toast diet, how much water would you need to drink before you develop hyponatremia? I haven’t seen anyone work out the numbers before so here are my calculations. AndRead more

    • acute acidemia physiology

      As alluded to in the first post, don’t be fooled by a “normal” potassium in the setting of DKA because osmotic diuresis and H+/K+ exchange means that total body potassium is actually LOW. You all knowRead more

    • renal handling of potassium

      the first symptom of hyperkalemia is death Earlier post covered temporizing measures to counter hyperkalemia — namely, intracellular shift, increasing cardiac myocyte threshold potential. Give furosemide if the patient still urinates and consider dialysis, but then askRead more

    • bicarbonate revisited

      Previous post reviewed the safety of balanced crystalloids in hyper K. But what was up with serum bicarbonate decreasing with saline administration? This post introduces a new way of looking at the anion gap to possiblyRead more

    • hyperkalemia and balanced crystalloids

      Is it safe to give LR or plasmalyte to a hyperkalemic patient (these balanced crystalloids have 4-5 mEq/L K as opposed to 0 mEq/L K in normal saline)? Postponing the discussion of renal handling of potassium toRead more

    • hyperkalemia physiology

      You’ll likely encounter hyperkalemia on your next Resus / Cardiac shift, and you’ll instinctively treat it. But take a moment to review the fascinating physiology behind the “cocktail”! First, consider how K+ is buffered byRead more

    • Slow down your tachycardia (but not really)

      You’re sitting in resus bemoaning the departure of your most beloved attending when suddenly a patient wheels in without warning. The patient looks relatively stable but the triage RN tells you her heart rate wasRead more

    • Otitis externa: use the ear wick!

      Acute otitis externa (AOE) is a common complaint seen in pediatric as well as adult emergency departments. AOE is typically not accompanied by acute otitis media, although concurrent cases are possible. Also called “swimmer’s ear”Read more