MING-JU HSIEHZUI-SHEN YENSHYR-CHYR CHENCHENG-CHUNG FANG2020-12-282020-12-2820081472-0205https://scholars.lib.ntu.edu.tw/handle/123456789/534056Herbal 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.[SDGs]SDG3acetylcholinesterase; analgesic agent; atropine; bronchodilating agent; Flemingia macrophylla extract; ginseng extract; plant extract; unclassified drug; acute cholinergic syndrome; aged; article; bradycardia; case report; contaminated plant; diarrhea; drug eruption; dyspnea; enzyme activity; erythrocyte; Flemingia macrophylla; fluid therapy; herb; human; hypersalivation; hyperthermic therapy; hypokalemia; hypotension; hypothermia; leukocytosis; low back pain; lumbar disk hernia; male; miosis; neurologic disease; oxygen therapy; priority journal; respiratory acidosis; side effect; sinus rhythm; sweating; vomiting; wheezing; Acetylcholinesterase; Aged; Drug Contamination; Drugs, Chinese Herbal; Erythrocytes; Humans; Male; Pesticides; Phytotherapy; Syndromejournal article10.1136/emj.2008.060889189556282-s2.0-56249106913