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Acute cholinergic syndrome following ingestion of contaminated herbal extract
  1. M-J Hsieh,
  2. Z-S Yen,
  3. S-C Chen,
  4. C-C Fang
  1. Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
  1. Dr C-C Fang, Department of Emergency Medicine, National Taiwan University Hospital, No 7, Chung Shan South Road, Taipei 100, Taiwan; conrad{at}


Herbal preparations are becoming more and more popular and increasingly used in the USA. Herbs are from natural plants and therefore often considered to be harmless compared with western medicines. Nevertheless, as the use of herbal remedies has risen, so has the incidence of acute and chronic herbal intoxication. The case history is presented of a 68-year-old man who presented with an acute cholinergic syndrome soon after ingesting a herbal preparation containing Flemingia macrophylla and ginseng. His red blood cell acetylcholinesterase activity dropped to 50% of the normal reference range. He was treated successfully with atropine and supportive care. It was thought that contamination with pesticides, such as organophosphate residue, was the probable cause. This case highlights the need to be more aware of the possibility of acute pesticide intoxication in herbal users, even when only small amounts are consumed.

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  • Funding: This article was supported by the Ta-Tung Kidney Foundation and the Mrs Hsiu-Chin Lee Kidney Research Fund.

  • Competing interests: None.