Divergent clinical outcomes after shared poison hemlock ingestion: evidence suggesting a dose-related effect

Poison hemlock (Conium maculatum) ingestion is rare in contemporary emergency medicine but may result in rapidly progressive neuromuscular paralysis and respiratory failure. Because exposure is often unrecognized at presentation, emergency management decisions – particularly airway control – must frequently be made in the setting of diagnostic uncertainty. We report two patients who presented to the emergency department of Marmara University Pendik Training and Research Hospital in Istanbul, Türkiye after ingesting the same meal prepared from wild greens later identified as poison hemlock. Despite a shared exposure, their clinical courses differed markedly. One patient developed early respiratory muscle involvement with progressive ventilatory failure requiring endotracheal intubation and intensive care admission, whereas the second patient experienced only mild, self-limited neuromuscular symptoms managed with close observation. These cases illustrate how differences in ingested dose may lead to variable degrees of neurotoxicity following poison hemlock ingestion and emphasize that airway management decisions in the emergency department should be guided by physiological deterioration rather than diagnostic certainty.