people who recover usually regain consciousness and seizures cease within 24 to 48 hours of poisoning, although seizures may persist for up to 96 hours. There are occasional long-term effects, such as retrograde amnesia of the events leading to intoxication and the intoxication itself. Other ongoing mild effects may include restlessness, muscle weakness, twitching, and anxiety. Complete resolution of symptoms may take a number of days, or these ongoing symptoms may persist for months after poisoning. Diagnosis and treatment Water hemlock poisoning is usually diagnosed following a history of plant ingestion and symptoms of abrupt onset of seizures. Laboratory tests to determine the presence of cicutoxin in the blood such as spectrofluorimetry, high pressure liquid chromatography, thin layer chromatography, and mass spectrometry have been used to detect cicutoxin, but these tests are not performed routinely in hospital laboratories. If a sample of the plant ingested has been retained, diagnosis can be confirmed by having the plant identified by a botanist. Initial treatment of poisoning may include gastrointestinal decontamination with activated charcoal. Decontamination is typically performed only if a potentially toxic amount of plant matter has been ingested up to one hour previously, and the patient has a normal intact airway or has been intubated. There is no specific antidote for water hemlock poisoning, and treatment consists mainly of supportive care. Treatment may include control of seizures with the administration of a benzodiazepines such as lorazepam or diazepam, or, if seizures are refractory to this treatment, a barbiturate such as phenobarbital is administered. The anticonvulsant phenytoin is not recommended, as it has not been shown to be effective for seizure control following water hemlock poisoning. Treatment with high doses of benzodiazepines or barbiturates may cause respiratory depression, and respiratory support including intubation and mechanical ventilation is required in these patients. Continuous electroencephalography monitoring is recommended in symptomatic patients. Further treatment for complications of metabolic acidosis, rhabdomyolysis, hyperthermia, or low blood pressure may be required. Metabolic acidosis is treated by administering sodium bicarbonate. Low blood pressure is usually treated with intravenous fluid replacement, but the administration of dopamine or norepinephrine may be required to restore blood pressure. The management of rhabdomyolysis includes ensuring adequate hydration and urinary alkalinization; a complication of rhabdomyolysis is acute kidney injury, which may require management with hemodialysis. However, hemodialysis, hemoperfusion, or other extracorporeal techniques do not remove cicutoxin from the blood and are therefore not useful in