plant toxicity. introduction frequency of plant exposure by plant type §capsicum (pepper...

Plant Toxicity

Introduction

Frequency of Plant Exposure by Plant Type

Capsicum (pepper plant)(5374 exposures)Philodendron (4061)Holly (3441)Euphorbia sp. (poinsettia) (3296)Dieffenbachia (dumbcane) (2141)

Non Toxic PlantsAfrican violet BegoniaBoston fern Christmas cactusColeus Corn plantCrab apple DaisiesDandelion Easter LillyHibiscus Jade plantMagnolia MarigoldPetunia Prayer plantSnake plant Velvet plant

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 plantsAccount for 5-10% of calls to poison control center

Incidence is increasingToxicity's can also occur when plants have been

treated with herbicides, insecticides or fertilizers

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

General management of a Plant poisoned patientTreat all cases of plant ingestion as potentially

toxic until shown otherwiseFirst try and ID the plant, try to get actual plant

if possibleTime is on the side of the patient, determine

when exposure happened.Determine how much was ingested.

Call poison control center

General management of a Plant poisoned patient

Demulcent therapy - ice cream, milk, egg whites

Observe patient for clinical signsIf indicated induce vomiting - syrup of Ipecac

Activated charcoal should be given Cathartics hasten removal of remaining

material

Common Poisonous Plants

Arum familyMost 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 crystalsUsed for variety of purposes: punishing slaves,

treating gout, impotence and frigidity

Signs, Symptoms and TreatmentNon 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)

Caladium

Dumbcane

Split leafed Philodendron

Christmas plants

American HollyMistletoePoinsettia

American Holly

Berries are toxic, contain IlicinClinical signs

Nausea, severe vomiting, abdominal pain, diarrhea

Treatment - Ipecac, activated charcoal

Jerusalem Cherry

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

Poinsettia

Non toxiccontains a latex sap which can be

slightly irritating to mucous membranes

Treatment - give demulcents

Poinsettia

Cardiotoxic Plants

Contain cardiac glycosidesOleanderAzaleasLilly of the valley

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.

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)

Oleander

Very toxic plant, common ornamentalClinical signs

GIT irritation, vomiting, abdominal pain, diarrhea, hyperkalemia, AV block, cardiogenic shock

Treatment - Ipecac, activated charcoal, transport

Oleander

Oleander

Oleander

Azaleas

Rhododendron, Bird of paradisecontain andromedotoxinTreatment - Ipecac, activated charcoal,

transport

Azaleas

Azaleas

Castor Bean

Castor beanContain phytotoxins - ricin - inactivated by heat

during the production of castor oilseeds are the most toxic part of the plant, 2-4

seeds could be fatal in adultClinical signs

nausea, violent vomiting and diarrhea, burning sensation in the mouth, hemolysis, renal failure, death

Treatment - Ipecac, activated charcoal, transport

Castor bean

CastorBean

CastorBean

Rhubarb

Rhubarb

Leaves are toxic, contain oxalic acid, heating does not destroy the toxic principle

Stems are edibleClinical signs

abdominal pain, vomiting, diarrhea, headache, muscle cramps, tetany, renal failure

Treatment - Ipecac, activated charcoal, transport

Rhubarb

Rhubarb, stem

Rhubarb

Rhubarb,flowers

JimsonweedDatura stramonium

Jimsonweed ToxicityPlant alkaloids are metabolites that have a nitrogen

containing chemical ringThis 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 deathsToxicity manifests as classic anticholinergic posioning

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 teaReports of smoking the leaves of the plant

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

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

Jimsonweed,thorn apple, angel’s trumpet

Jimsonweed, flowers

Jimsonweed, seed pod

Pokeweed

Pokeweed

AKA Inkberry, pigeonberryRoots and leaves are the most toxic, fruit is

mildly toxicToxic principle is a resinous material and a

water soluble saponin

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

Pokeweed, Ink berries

Pokeweed, Ink berries

Pokeweed

Pokeweed

Toxicodendron

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

Poison Ivy50-70% of US population is susceptiblePoison 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

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

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

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.

Toxicodendron, Poison Ivy

Poison Ivy

“Leaflets of three,let it be”

Poison Ivy

Poison Ivy

Poison Ivy

Other urushiol containing plants: cashew nut shells - exposure to unroasted

cashew nut shells can cause a reaction, roasting inactivates the allergen.

mango tree - mango fruit skin can cause reactions in sensitive individuals

ginkgo tree

Mushroom Toxicity

Mushroom toxicity1999 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

Mushroom toxicity

Never eat any wild mushroom Etiology - consumption of raw or cooked

mushrooms/toadstoolsCooking, canning or freezing WILL NOT

render toxic mushrooms non toxicClinical Syndromes - usually acute onset of

signs and symptoms

Categories of Mushroom ToxicityI) Protoplasmic poisons - destruction of cellsSigns 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

Examples of Mushrooms which cause protoplasmic poisoning

Amanita phalloides

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

Amanita phalloides

Amanita phalloides

Categories of Mushroom Toxicity, cont.

II) Neurotoxins contain compounds which cause neurological

signs and symptoms, convulsions, hallucinations, excitation, depression, spastic colon.

Examples of Mushrooms which cause Neurologic signs and

symptoms

Amanita muscarina

Inocybe sp.

Inocybe sp.

Inocybe sp.

Inocybe sp.

Psilocybe sp.

Psilocybe sp.

Categories of Mushroom Toxicity, cont.

III) Gastrointestinal irritants cause nausea, vomiting, abdominal cramping,

diarrhea

Examples: green gill, gray pink gill, etc.

Green gillThese 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.

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.

Green gill, green spored

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

Inky cap mushroom

Diagnosis of Human toxicity

Clinical testingHistoryOutbreaks are not very commonUsually isolated cases - seen in people who

go out picking mushroomsPatient management - induce vomiting, give

activated charcoal, seek medical help