Plant poisoning

1. Plant poisoning
Dr. Kalirattiname

2. Toxic Plants
One of the most frequent poisonings reported to
poison control centers
69% of plant exposures reported to poison control
centers involved children > 6 yrs.
15,000 people a year poisoned by plants
Account for 5-10% of calls to poison control
center
Incidence is increasing
Toxicity's can also occur when plants have been
treated with herbicides, insecticides or fertilizers

3. Toxic Plants, cont.
Almost any plant can cause nausea, vomiting and
intestinal cramping
Not all parts of a plant are always toxic and the
toxic principle may be present only during certain
times of the year

4. General management of a Plant
poisoned patient
Treat all cases of plant ingestion as potentially
toxic until shown otherwise
First try and ID the plant, try to get actual plant
if possible
Time is on the side of the patient, determine
when exposure happened.
Determine how much was ingested.
Call poison control center

5. General management of a Plant
poisoned patient
Demulcent therapy - ice cream, milk, egg
whites
Observe patient for clinical signs
If indicated induce vomiting - syrup of Ipecac
Activated charcoal should be given
Cathartics hasten removal of remaining
material

6. Common Poisonous Plants

7. Arum family
Most common toxic plant exposure reported in the
US. And a very common plant in homes and
public places
Members of the Arum family:
caladium
dieffenbachia - dumbcane
philodendron
Contain calcium oxalate crystals
Used for variety of purposes: punishing slaves,
treating gout, impotence and frigidity

8. Signs, Symptoms and Treatment
Non soluble needle like Ca++ oxylate crystals are
found in all parts of the plant, stalk produces most
severe reaction
Biting into the plant causes
pain and irritation to the mucous membranes of the
mouth and intense salivation
edema when they contact lips, tongue, oral mucosa
choking
Treatment
supportive care and demulcents (milk)

9. Caladium

10. Dumbcane

12. Split leafed
Philodendron

13. Christmas plants
American Holly
Mistletoe
Poinsettia

14. American Holly
Berries are toxic, contain Ilicin
Clinical signs
Nausea, severe vomiting, abdominal pain,
diarrhea
Treatment - Ipecac, activated charcoal

15. Jerusalem
Cherry

16. Mistletoe
Berries are toxic , contain B-phenylethylamine
and tyramine
Clinical signs
acute gastroenteritis, cardiovascular collapse,
nausea, vomiting, respiratory difficulty, delirium,
hallucinations, death
Treatment - Ipecac, activated charcoal, transport

17. Poinsettia
Non toxic
contains a latex sap which can be
slightly irritating to mucous
membranes
Treatment - give demulcents

18. Poinsettia

19. Cardiotoxic Plants
Contain cardiac glycosides
Oleander
Azaleas
Lilly of the valley

20. Cardiotoxic plants
First used by Egyptians as emetics and for
heart aliments
Toxicity occurs usually after consuming
teas or consuming parts of the plant
More than 200 naturally occurring cardiac
glycosides have been Ided.
Mech of Action - bind to cell membrane
and inhibit the Na/K pump.

21. Cardiotoxic plants
Clinical signs:
tachycardia
V fib
Toxic exposure is rare
AAPCC reports in 1998 - 2,553 exposures (out of 2.24
million exposures to toxic substances)
Mortality is rare - 1998 AAPCC reported one death
Most common age of exposure is children under the age of
6 years (72.5% of exposures)

22. Oleander
Very toxic plant, common ornamental
Clinical signs
GIT irritation, vomiting, abdominal pain,
diarrhea, hyperkalemia, AV block, cardiogenic
shock
Treatment - Ipecac, activated charcoal,
transport

23. Oleander

24. Oleander

25. Azaleas
Rhododendron, Bird of paradise
contain andromedotoxin
Treatment - Ipecac, activated charcoal,
transport

26. Azaleas

27. Castor Bean

28. Castor bean
Contain phytotoxins - ricin - inactivated by heat
during the production of castor oil
seeds are the most toxic part of the plant, 2-4
seeds could be fatal in adult
Clinical signs
nausea, violent vomiting and diarrhea, burning
sensation in the mouth, hemolysis, renal failure,
death
Treatment - Ipecac, activated charcoal, transport

29. Castor
Bean

30. Rhubarb

31. Rhubarb
Leaves are toxic, contain oxalic acid, heating
does not destroy the toxic principle
Stems are edible
Clinical signs
abdominal pain, vomiting, diarrhea, headache,
muscle cramps, tetany, renal failure
Treatment - Ipecac, activated charcoal, transport

32. Rhubarb

33. Jimsonweed
Datura stramonium

34. Jimsonweed Toxicity
Plant alkaloids are metabolites that have a nitrogen
containing chemical ring
This plant has a history of hallucinogenic use and has
been connected to sorcery, witchcraft and native
medicine dating back to 1500 BC
Marc Anthony’s military troops were neutralized and
defeated after ingesting this plant
318 cases reported to AAPCC with 2 deaths
Toxicity manifests as classic anticholinergic posioning

35. Jimsonweed Toxicity
toxic agents - solanaceous alkaloids, atropine,
hyoscyamine and scopolamine
highest concentration of active agents is in the
seeds (0.1 mg atropine per seed)
As little as 1/2 tsp. of seeds has caused death from
pulmonary arrest
handling the seeds or leaves and rubbing the eyes
can cause mydriasis
Seeds can be made into a tea
Reports of smoking the leaves of the plant

36. Jimsonweed toxicity, cont.
Clinical features:
tachycardia, dry flushed skin, dry mucous
membranes, mydriasis, blurred vision,
hyperpyrexia, urinary retention,
confusion, disorientation, loss of short
term memory, ataxia, visual and auditory
hallucinations, psychosis, death

37. Jimsonweed toxicity, cont.
“Mad as a hatter, red as a beet, dry as a
bone, blind as a bat and hot as a hare”
Treatment
maintain airway
transport
do not induce vomiting and defer
administration of activated charcoal unless
prolonged transport time is anticipated

38. Jimsonweed,
thorn apple,
angel’s trumpet

39. Jimsonweed, seed pod

40. Pokeweed

41. Pokeweed
AKA Inkberry, pigeonberry
Roots and leaves are the most toxic, fruit is
mildly toxic
Toxic principle is a resinous material and a
water soluble saponin

42. Poke weed
Clinical signs
produces a burning sensation in the mouth, GI
cramps, vomiting, diarrhea, visual disturbances,
diaphoresis, salivation, prostration, can be fatal
To prepare pokeweed your must boil the
leaves twice to remove the toxic principle
Treatment - Ipecac, activated charcoal,
transport

43. Pokeweed, Ink berries

44. Toxicodendron

45. Poison Ivy
All portions of the plant, even the smoke from
burning leaves
Toxic principle - an oily oleoresin called
urushiol
Urushiol can be transmitted from person to
person or other vehicles by direct contact

46. Poison Ivy
50-70% of US population is susceptible
Poison ivy east of the Rockies, poison oak
west and poison sumac in the south east.
Clinical signs
severe allergic contact dermatitis 12-24 hours
post exposure, blistering, inflammation, and
vesicle formation
Urushiol penetrates skin and binds to
membrane lipids within 10-20 minutes of
exposure

47. Poison Ivy, cont.
Treatment:
avoid contact, wash affected area with soap and
rinse with alcohol, repeat
2 tbsp. Epsom’s salt/cup of water, sponge onto
the affected area and allow to dry, 2-3
times/day
Electronic itch stopper
Tecnu cleanser
corticosteroids, topically and orally
histamine blockers

48. Poison Ivy, cont.
Treatment: cont.
calamine lotion
zinc oxide ointment
baking soda paste (one tablespoon of baking
soda to one teaspoon of water)
baths in oatmeal soap or medicated oatmeal
based products like Avenno.
Zanfel - binds to urushiol
Ivy Block - a pre-exposure preventative

50. Poison Ivy, cont.
Treatment: cont.
If you were exposed to the smoke of burning
poison ivy, oak or sumac and you believe you
may have breathed in the fumes, you need to
seek medical treatment immediately.
Some people can have life threatening reactions
from inhaling urushiol vapors into their lungs.
In some states, it is illegal to burn poison ivy
due to the health risks it represents.

51. Poison Ivy

52. Mushroom Toxicity

53. Mushroom toxicity
1999 AAPCC reported 8996 mushroom
exposures, 2930 treated in a hospital and 6
fatalities
5976 of these ingestions were in children > 6
years
Amanitin phalloides accounts for 90-95% of
all fatalities from mushroom poisoning in
North America

54. Mushroom toxicity
Never eat any wild mushroom
Etiology - consumption of raw or cooked
mushrooms/toadstools
Cooking, canning or freezing WILL NOT
render toxic mushrooms non toxic
Clinical Syndromes - usually acute onset of
signs and symptoms

55. Categories of Mushroom Toxicity
I) Protoplasmic poisons - destruction of cells
Signs and Symptoms
Stage I - first 6-24 hrs., severe abdominal pain,
severe diarrhea
Stage II - 24-48 hrs., apparent recovery , cellular
destruction is occurring in the kidney and liver
Stage III - 3-5 days post ingestion, liver and
kidney failure, death can occur 4-7 days post
ingestion
Treatment - induce vomiting, transport

56. Examples of Mushrooms which
cause protoplasmic poisoning

57. Amanita phalloides
Contain a mixture of heat stable
cyclopeptides including:
phalloidin
phalloin
amatoxin - accounts for the lethality

58. Amanita phalloides

59. Categories of Mushroom Toxicity, cont.
II) Neurotoxins
contain compounds which cause neurological
signs and symptoms, convulsions,
hallucinations, excitation, depression, spastic
colon.

60. Examples of Mushrooms which
cause Neurologic signs and
symptoms

61. Amanita
muscarina

62. Inocybe sp.

63. Inocybe sp.

64. Inocybe sp.

65. Inocybe sp.

66. Psilocybe sp.

67. Psilocybe sp.

68. Categories of Mushroom Toxicity, cont.
III) Gastrointestinal irritants
cause nausea, vomiting, abdominal cramping,
diarrhea
Examples: green gill, gray pink gill, etc.

69. Green gill
These large, common mushrooms often
appear in fairy rings on suburban lawns,
commonly called toadstools.
They cause violent gastrointestinal upset.
Is parasol-shaped and has a cream or tan,
scaly cap, a large ring on the stem and
cream-colored gills which turn dingy green
with age.

70. Green gill, cont.
As its name suggests, it is the only
mushroom with a greenish spore print. Size
4" to 12" tall, 2" to 12" in diameter.
This mushroom is found in summer and
fall, on the ground in lawns, pastures and
meadows.

71. Green gill, green spored

72. Categories of Mushroom Toxicity, cont.
IV) Disulfiram-like compounds
generally non toxic and produce no clinical
signs unless alcohol is consumed within 72
hours of eating them.
Example - inky cap mushroom

73. Inky cap mushroom

74. Diagnosis of Human toxicity
Clinical testing
History
Outbreaks are not very common
Usually isolated cases - seen in people who
go out picking mushrooms
Patient management - induce vomiting, give
activated charcoal, seek medical help