COMMON POISONOUS PLANTS COMMON POISONOUS PLANTS IN SRI LANKAIN SRI LANKA

Dr. R.T.Y.S. RANAWAKA – MEDICAL OFFICERDr. R.T.Y.S. RANAWAKA – MEDICAL OFFICER

MRS. A.VITHANAGE – RESEARCH OFFICERMRS. A.VITHANAGE – RESEARCH OFFICER

NATIONAL POISONS AND DRUG NATIONAL POISONS AND DRUG INFORMATION CENTREINFORMATION CENTRE

NATIONAL HOSPITAL - COLOMBONATIONAL HOSPITAL - COLOMBO

DIVI KADURU – Eve’s appleDIVI KADURU – Eve’s apple

(Tabernaemantana dichotoma(Tabernaemantana dichotoma))

DIVI KADURU DIVI KADURU Contd…Contd… Identification:Identification:

*Tree *Tree -- Small, dichotomously branched.Small, dichotomously branched. *Leaves *Leaves -- Oppositely arranged and oblong in Oppositely arranged and oblong in

shape.shape. *Fruit*Fruit - - Fleshy, pendulous horizontally Fleshy, pendulous horizontally

divided into two parts, orange, yellowish divided into two parts, orange, yellowish in in colour.colour.

*Seeds*Seeds - - Surrounded by a coat of crimson Surrounded by a coat of crimson pulp. Seeds are purgative, narcotic and pulp. Seeds are purgative, narcotic and

poisonous, producing toxic substancepoisonous, producing toxic substance similar to Atropine poisoning.similar to Atropine poisoning.

Symptoms and SignsSymptoms and Signs In mild poisoningIn mild poisoning - headache, nausea, vomiting, - headache, nausea, vomiting,

diarrhoea can occur. diarrhoea can occur.

In severe poisoningIn severe poisoning - anticholinergic symptoms - anticholinergic symptoms can occur. can occur. dryness of the mucous dryness of the mucous membranes, thirst , dilation of membranes, thirst , dilation of

pupils, flushing of the face, pupils, flushing of the face, tachycardia, psychomotor tachycardia, psychomotor disturbances, fits of crying, disturbances, fits of crying, disturbances of disturbances of consciouness, consciouness, delirium, convulsion. delirium, convulsion.

DIVI KADURU Contd…DIVI KADURU Contd…

DIVI KADURU Contd…DIVI KADURU Contd…

ManagementManagement–Check A,B,C, –Check A,B,C, Do gastric lavage within 1-2 hrs of Do gastric lavage within 1-2 hrs of

ingestion. ingestion. Give activated charcoal 50-100g in Give activated charcoal 50-100g in 200ml 1-2 hrs of ingestion. 200ml 1-2 hrs of ingestion.

Severe delirium - physostigmine.Severe delirium - physostigmine. Convulsions - diazepam.Convulsions - diazepam. Treat symptomatically where Treat symptomatically where

necessary. necessary.

GODA KADURU / Bitter nutGODA KADURU / Bitter nut (Strychnos nux vomica)(Strychnos nux vomica)

GODA KADURU GODA KADURU Contd…Contd… Identification:Identification:

*Tree*Tree – Smooth yellowish – grey bark and shiny – Smooth yellowish – grey bark and shiny

5 nerved leaves.5 nerved leaves.

*Fruit *Fruit – Round hard glossy orange in colour – Round hard glossy orange in colour

with jelly like white or pale yellow pulpwith jelly like white or pale yellow pulp ..

*Seeds *Seeds – Ash grey coloured seeds are concave on – Ash grey coloured seeds are concave on one side and convex on the other side.one side and convex on the other side.

*Toxic substance*Toxic substance – Alkaloid strychnine, found in – Alkaloid strychnine, found in seeds has a selective action seeds has a selective action on the central nervous on the central nervous system.system.

*Lethal dose*Lethal dose – One seed could be lethal. – One seed could be lethal.

GODA KADURUGODA KADURU Contd… Contd…

Toxicity is the result of antagonizing Toxicity is the result of antagonizing the central inhibitory neuro-the central inhibitory neuro-transmitter glycine by blocking it’s transmitter glycine by blocking it’s post synaptic uptake at brain stem post synaptic uptake at brain stem and spinal cord.and spinal cord.

This causes hyper-excitation of This causes hyper-excitation of muscles.muscles.

GODA KADURUGODA KADURU Contd… Contd… Signs and Sym. Following ingestionSigns and Sym. Following ingestion

** In mild cases there is apprehension, muscle twitching, cramps In mild cases there is apprehension, muscle twitching, cramps and hyper‑reflexia. In severe poisoning, repeated symmetrical and hyper‑reflexia. In severe poisoning, repeated symmetrical painful convulsions are observed.  They are characterized by painful convulsions are observed.  They are characterized by extensor spasms, risus sardonicus, and opisthotonus. extensor spasms, risus sardonicus, and opisthotonus. 

   ** Hyperthermia, metabolic acidosis, rhabdomyolysis, Hyperthermia, metabolic acidosis, rhabdomyolysis,

myoglobinuria and renal failure are the other features of myoglobinuria and renal failure are the other features of poisoning.poisoning.

  ** The convulsions may last from half to two minutes and is The convulsions may last from half to two minutes and is

followed by a period of relaxation.  The patient is conscious followed by a period of relaxation.  The patient is conscious during the painful convulsions.during the painful convulsions.

  ** Consciousness is lost following repeated convulsions and Consciousness is lost following repeated convulsions and

death results from respiratory failure.death results from respiratory failure.

GODA KADURUGODA KADURU Contd… Contd… ManagementManagement

*Check A, B,C *Check A, B,C

*Convulsions - Diazepam 5-10 IV. Repeat if necessary.*Convulsions - Diazepam 5-10 IV. Repeat if necessary.

To control convulsions phenobarbitone,To control convulsions phenobarbitone,

phenytoin also can use.phenytoin also can use.

*After convulsions are controlled consider gastric lavage and *After convulsions are controlled consider gastric lavage and

give activated charcoal when appropriate.give activated charcoal when appropriate.

*To correct acidosis –Sodium bicarbanate*To correct acidosis –Sodium bicarbanate

*If facilities available monitor blood gases SE/BU*If facilities available monitor blood gases SE/BU

*Manage the patient in a quiet place with minimal stimuli to *Manage the patient in a quiet place with minimal stimuli to

prevent Convulsions.prevent Convulsions.

Diya kaduruDiya kaduru/Wel Kaduru/Gon Kaduru/Wel Kaduru/Gon Kaduru ((Cerbera manghas)Cerbera manghas)

DIYA KADURU DIYA KADURU Contd…Contd…

IdentificationIdentification – Growing near the sea, both in – Growing near the sea, both in the wet / dry zones. the wet / dry zones.

FlowersFlowers – Pure white with a small yellow – Pure white with a small yellow heart.heart.

FruitsFruits – Rounded green in colour turning in to – Rounded green in colour turning in to pink black. Feature of the ripe fruit is look pink black. Feature of the ripe fruit is look likes a mango. Outer fibrous covering and likes a mango. Outer fibrous covering and hence floats.hence floats.

DIYA KADURU DIYA KADURU Contd…Contd…

ToxicityToxicity – Cardiotoxic kernel of the fruit – Cardiotoxic kernel of the fruit contains the cardiac glycosides, contains the cardiac glycosides, cerberine, odollum, thevetin.cerberine, odollum, thevetin.

Toxic partToxic part – Kernel of the fruits. Two – Kernel of the fruits. Two fruits sufficient to cause death (if not fruits sufficient to cause death (if not vomited).vomited).

DIYA KADURU DIYA KADURU Contd…Contd…

Sym. & SignsSym. & Signs following ingestion following ingestion – – Burning sensation and dryness of the Burning sensation and dryness of the

mouth, nausea, vomiting, diarrhoea mouth, nausea, vomiting, diarrhoea

and abdominal pain are early features.and abdominal pain are early features. CVS – Bradycardia,hypotension, CVS – Bradycardia,hypotension, 11stst and 2 and 2ndnd degree heart block atrial and degree heart block atrial and

ventricular extrasystoles, ventricular ventricular extrasystoles, ventricular fibrillation.fibrillation. Convulsions and coma also can occur. Convulsions and coma also can occur.

DIYA KADURU DIYA KADURU Contd…Contd…

ManagementManagement

*Consider gastric lavage when appropriate.*Consider gastric lavage when appropriate.

*Give activated charcoal when appropriate.*Give activated charcoal when appropriate.

*Do BU/SE, arterial blood gases.*Do BU/SE, arterial blood gases.

*Treat symptomatically where necessary.*Treat symptomatically where necessary.

KANERUKANERU Nerium oleander Thevetia peruvianaNerium oleander Thevetia peruviana

KANERUKANERU Contd…Contd…

Identification:Identification: Small tree with a milky sap. The leaves are dark green, Small tree with a milky sap. The leaves are dark green,

glossy, linear alternating on the stem.glossy, linear alternating on the stem. FlowersFlowers – Large funnel shaped yellow, pink, red and white – Large funnel shaped yellow, pink, red and white

flowers grouped at the end of the branches.flowers grouped at the end of the branches. FruitFruit – Green when immature, yellow to black when ripe, – Green when immature, yellow to black when ripe,

triangular in out line with a raised ridge around the middle. triangular in out line with a raised ridge around the middle. Toxic substanceToxic substance – Cardiac glycosides, Thevetin A and – Cardiac glycosides, Thevetin A and

Thevetin B.Thevetin B. Toxic partToxic part – All parts of plant especially the fruits. – All parts of plant especially the fruits. Fatality Fatality – Ingestion of the kernel of one fruit may prove to be – Ingestion of the kernel of one fruit may prove to be

fatal to childfatal to child

KANERUKANERU Contd…Contd…

*Ingestion of the fruit causes nausea and vomiting early, *Ingestion of the fruit causes nausea and vomiting early,

due to the local irritant effect of the stomach. due to the local irritant effect of the stomach.

    Vomiting 6 to 12 hours after ingestion implies Vomiting 6 to 12 hours after ingestion implies significant absorption of the toxin.significant absorption of the toxin.

*Cardio‑toxicity causes bradycardia, varying degrees of *Cardio‑toxicity causes bradycardia, varying degrees of heart block and hypotension.  There may be atrial and heart block and hypotension.  There may be atrial and ventricular ectopics and other ventricular arrhythmias.ventricular ectopics and other ventricular arrhythmias.

*Other toxic effects are yellow vision (xanthopsia), *Other toxic effects are yellow vision (xanthopsia), anxiety, convulsions and coma.anxiety, convulsions and coma.

KANERUKANERU Contd…Contd…ManagementManagement

* An asymptomatic patient should be observed in a hospital for 24 hours.* An asymptomatic patient should be observed in a hospital for 24 hours.

* Consider gastric lavage when appropriate.* Consider gastric lavage when appropriate.

* Give activated charcoal when appropriate and repeat it the rate of 12.5- 25g * Give activated charcoal when appropriate and repeat it the rate of 12.5- 25g every 4 hrs until recovery.every 4 hrs until recovery.

* Monitor pulse,BP and respiration and maintain a fluid balance chart.* Monitor pulse,BP and respiration and maintain a fluid balance chart.

* Check SE four hourly* Check SE four hourly

* If facilities are available do cardiac monitoring, otherwise do ECGs.* If facilities are available do cardiac monitoring, otherwise do ECGs.

* Treat symtomatically where necessary.* Treat symtomatically where necessary.* Convulsion – Diazepam 5 -10 mg IV.* Convulsion – Diazepam 5 -10 mg IV.* Bradycardia – Atropine 0.5 to 2mg IV. * Bradycardia – Atropine 0.5 to 2mg IV.

OLINDA / Crab’s eyeOLINDA / Crab’s eye(Abrus precatorius(Abrus precatorius))

OLINDA OLINDA Contd…Contd…

IdentificationIdentification – Slender creeper with – Slender creeper with alternatively placed compound leaves, flowers alternatively placed compound leaves, flowers purple crowded at the end of a stalk.purple crowded at the end of a stalk.

SeedsSeeds – Highly attractive seeds, hard shiny and – Highly attractive seeds, hard shiny and scarlet in colour with black eye at the hilus.scarlet in colour with black eye at the hilus.

Toxic substanceToxic substance – Toxalbumin called – Toxalbumin called AbrinAbrin Toxic partToxic part – Seeds are extremely poisonous. – Seeds are extremely poisonous.

Even a single cracked seed can be fatal. Even a single cracked seed can be fatal.

OLINDA OLINDA Contd…Contd… Nausea, vomiting, diarrhoea and abdominal cramps are observed Nausea, vomiting, diarrhoea and abdominal cramps are observed

due to the irritant effect on the gastro-intestinal mucosa by abrin. due to the irritant effect on the gastro-intestinal mucosa by abrin. Erosions of the mucosa result in haematemesis and melaena.Erosions of the mucosa result in haematemesis and melaena.

   Hepatotoxicity is manifested by elevated levels of transaminases Hepatotoxicity is manifested by elevated levels of transaminases

and serum bilirubin.and serum bilirubin.   Haemaglutination and haemolysis of red cells, hypovolaemic Haemaglutination and haemolysis of red cells, hypovolaemic

shock and direct toxic effect on kidneys lead to acute renal shock and direct toxic effect on kidneys lead to acute renal failure. failure.

   Retinal haemorrhages, pallor due to anaemia, hypoglycaemia, Retinal haemorrhages, pallor due to anaemia, hypoglycaemia,

drowsiness and convulsions are some of the other features drowsiness and convulsions are some of the other features observed.observed.

  

OLINDA OLINDA Contd…Contd…

Nausea, vomiting, diarrhoea and abdominal cramps are observed due to the Nausea, vomiting, diarrhoea and abdominal cramps are observed due to the irritant effect on the gastro-intestinal mucosa by abrin. Erosions of the irritant effect on the gastro-intestinal mucosa by abrin. Erosions of the mucosa result in haematemesis and melaena.mucosa result in haematemesis and melaena.

   Hepatotoxicity is manifested by elevated levels of transaminases and serum Hepatotoxicity is manifested by elevated levels of transaminases and serum

bilirubin.bilirubin.   Haemaglutination and haemolysis of red cells, hypovolaemic shock and Haemaglutination and haemolysis of red cells, hypovolaemic shock and

direct toxic effect on kidneys lead to acute renal failure. direct toxic effect on kidneys lead to acute renal failure.    Retinal haemorrhages, pallor due to anaemia, hypoglycaemia, drowsiness Retinal haemorrhages, pallor due to anaemia, hypoglycaemia, drowsiness

and convulsions are some of the other features observed.and convulsions are some of the other features observed.  

OLINDA OLINDA Contd…Contd…MANAGEMENTMANAGEMENT

If seeds were swalled without chewing, If seeds were swalled without chewing, toxicity is unlikely and decontamination is not toxicity is unlikely and decontamination is not needed.needed.

If uncertain, give activated charcoal.If uncertain, give activated charcoal. Monitor pulse, respiration and BP and Monitor pulse, respiration and BP and

maintain a fluid balance chart.maintain a fluid balance chart. Check SECheck SE Treat symptomatically where appropriate.Treat symptomatically where appropriate.

HONDALAHONDALA(Adenia Palmata)(Adenia Palmata)

HONDALA HONDALA Contd…Contd…

Identification Identification – Perennial herb growing in wet – Perennial herb growing in wet zone.zone.

FruitsFruits – Closely resembles to passion fruit, – Closely resembles to passion fruit, responsible for accidental poisoning among responsible for accidental poisoning among children. Unripe fruit – Green colour, ripechildren. Unripe fruit – Green colour, ripe fruit – fruit – yellow organge or scarlet in colour. It is divided in yellow organge or scarlet in colour. It is divided in to 3 equal parts. Seeds are covered with soft, jelly to 3 equal parts. Seeds are covered with soft, jelly like material. It contains cyanogenic glycoside and like material. It contains cyanogenic glycoside and toxalbumin.toxalbumin.

Most toxic part is the FruitMost toxic part is the Fruit

HONDALA Contd…HONDALA Contd…

Clinical manifestations occur in three phases.Clinical manifestations occur in three phases.   First phaseFirst phase: Abdominal pain, diarrhoea, vomiting, fever, restlessness and dizziness : Abdominal pain, diarrhoea, vomiting, fever, restlessness and dizziness

are the main features.are the main features.   Second phaseSecond phase: Diarrhoea with blood and mucus, and pain and tenderness over the : Diarrhoea with blood and mucus, and pain and tenderness over the

right iliac fossa may be observed. These manifestations are due to necrotising right iliac fossa may be observed. These manifestations are due to necrotising enteritis.enteritis.

                                                                                                                                                                        Third phaseThird phase: This phase is believed to be due to hypersensitivity reactions and : This phase is believed to be due to hypersensitivity reactions and

occur 2 to 3 weeks after ingestion.  There is myocarditis with ECG changes, tender occur 2 to 3 weeks after ingestion.  There is myocarditis with ECG changes, tender enlarged liver, retinopathy with papilloedema, exudate and haemorrhages.enlarged liver, retinopathy with papilloedema, exudate and haemorrhages.

  

MANAGEMENTMANAGEMENT

Do gastric lavage when appropriate.Do gastric lavage when appropriate. Give activated charcoal when appropriateGive activated charcoal when appropriate Treat symtomatically where appropriate.Treat symtomatically where appropriate.

CASTOR OIL PLANTCASTOR OIL PLANTBeheth Endaru / Thel EndaruBeheth Endaru / Thel Endaru

(Ricinus communis)(Ricinus communis)

CASTOR OIL PLANTCASTOR OIL PLANTContd…Contd…

Identification:Identification:** Leaves Leaves - Very broad, roundish in outline and partly divided into 7 lobes, - Very broad, roundish in outline and partly divided into 7 lobes,

margins being toothed.margins being toothed.** FruitsFruits - - Has a prickly capsule and is lobulated.Has a prickly capsule and is lobulated.** Seeds Seeds - - Oval in shape have a brittle covering and are brown in colour Oval in shape have a brittle covering and are brown in colour with with irregular grey spots.irregular grey spots.

* * Toxic substance Toxic substance – Toxalbumin ‘ricin’. – Toxalbumin ‘ricin’. Ricin found throughout the plant with maximum concentration in the seeds.Ricin found throughout the plant with maximum concentration in the seeds. ** Ingestion of a single thoroughly chewed bean has caused fatal poisoning. Ingestion of a single thoroughly chewed bean has caused fatal poisoning.

RICINUS COMMUNIS J ATROPHA CURCAS

WETA ENDARUWETA ENDARU(Jatropha curcas)(Jatropha curcas)

IdentificationIdentification – Small tree/shrub with – Small tree/shrub with undulating five lobed leaves and undulating five lobed leaves and yellowish green flowers.yellowish green flowers.

Toxic substanceToxic substance – Toxalbumin curcin – Toxalbumin curcin (one of the most toxic substances among (one of the most toxic substances among plants) found throughout the plant with plants) found throughout the plant with maximum concentration in the seeds. maximum concentration in the seeds.

ENDARU ENDARU Contd…Contd…

Poisoning is observed only after a latent period of several Poisoning is observed only after a latent period of several hours. hours.

Signs and Sym. are nausea, vomiting, epigastric and Signs and Sym. are nausea, vomiting, epigastric and abdominal pain and diarrhoea resulting in dehydration, abdominal pain and diarrhoea resulting in dehydration, electrolyte imbalance, cramps and shock. electrolyte imbalance, cramps and shock. 

Other features of poisoning are hypoglycaemia, retinal Other features of poisoning are hypoglycaemia, retinal haemorrhages, haematuria, convulsions, and shock.  Hepatic haemorrhages, haematuria, convulsions, and shock.  Hepatic necrosis and acute renal failure have been reported.necrosis and acute renal failure have been reported.

  

ENDARU ENDARU Contd…Contd…MANAGEMENTMANAGEMENT

Do gastric lavage when appropriate.Do gastric lavage when appropriate. Give activated charcoal when appropriate.Give activated charcoal when appropriate. Check BU/SE, liver funtion test,Hb, Serum Check BU/SE, liver funtion test,Hb, Serum

creatinine.creatinine. Treat symtomatically where appropriate.Treat symtomatically where appropriate.

NIYANGALA / Glory LilyNIYANGALA / Glory Lily(Gloriosa superba)(Gloriosa superba)

NIYANGALA NIYANGALA Contd…Contd…

Common suicidal poison in rural areas.Common suicidal poison in rural areas. Identification Identification – A notable feature is the – A notable feature is the

colourful flower.colourful flower. Toxic partsToxic parts – All parts of the plant. – All parts of the plant. Toxic substance Toxic substance – Alkaloid Colchicine– Alkaloid Colchicine Lethal doseLethal dose – – AdultAdult: 6 mg to 20 mg (10 g of : 6 mg to 20 mg (10 g of

the fresh tubers contains about 6 mg of the fresh tubers contains about 6 mg of colchicine) colchicine) ChildrenChildren: 0.5 and 0.8 mg/kg: 0.5 and 0.8 mg/kg

NIYANGALA NIYANGALA Contd…Contd…

Toxic effects develop within 6 to 12 hours of Toxic effects develop within 6 to 12 hours of ingestion.ingestion.

Sigs &Sym.Sigs &Sym. - severe gastroenteritis with abnomial - severe gastroenteritis with abnomial pain, Nausea,Vomiting, Diarrhoea with blood …pain, Nausea,Vomiting, Diarrhoea with blood …dehydration…dehydration…

Hypovolaemia, hypotension, shock.Hypovolaemia, hypotension, shock.

11stst24 hrs later granulocytopenia, thrombocytopenia, 24 hrs later granulocytopenia, thrombocytopenia, clotting defects with bleeding manifestation.clotting defects with bleeding manifestation.

Cardic arrythmias, hepatic failure ,renal faure, res. Cardic arrythmias, hepatic failure ,renal faure, res. failure, DIC, convulsions and coma.failure, DIC, convulsions and coma.

NIYANGALA NIYANGALA Contd…Contd… MANAGEMENTMANAGEMENT

Do gastric lavage when appropriate.Do gastric lavage when appropriate. Give activated charcoal when appropriate. Give activated charcoal when appropriate.

Multiple dose activated charcoal may be Multiple dose activated charcoal may be helpful.helpful.

Treat symptomatically where appropriate.Treat symptomatically where appropriate.

ATTANA / Thorn AppleATTANA / Thorn Apple(Datura stramonium)(Datura stramonium)

ATTANA / Thorn Apple ATTANA / Thorn Apple Contd…Contd…

TreeTree – Small plant with dark green and pointed leaves. – Small plant with dark green and pointed leaves. FlowersFlowers are gramophone shaped and white or purple in are gramophone shaped and white or purple in

colour. Fruit is spherical thorny and attractive resemblin to colour. Fruit is spherical thorny and attractive resemblin to ‘rambutan’.‘rambutan’.

Seeds Seeds – Resemble gingelly seeds, yellowish brown in colour.– Resemble gingelly seeds, yellowish brown in colour. Toxic substanceToxic substance – Alkaloids atropine, hyoscine and – Alkaloids atropine, hyoscine and

hyoscyamine.hyoscyamine. Toxic partsToxic parts – Whole plant is poisonous, but seeds are the – Whole plant is poisonous, but seeds are the

most poisonous.most poisonous. Lethal doseLethal dose – Even a single seed is toxic. – Even a single seed is toxic.

ATTANA / Thorn Apple ATTANA / Thorn Apple Contd…Contd…

Signs and Sym.Signs and Sym. Similar to anticholinergic toxicity Similar to anticholinergic toxicity

* Thirst ,dryness of the mouth * Thirst ,dryness of the mouth

* CVS effects- sinus tachycadia,hypertension * CVS effects- sinus tachycadia,hypertension

supraventricular and ventricular dysrthythmiassupraventricular and ventricular dysrthythmias

* Dialated pupils and blurred vision* Dialated pupils and blurred vision

* Skin is hot dry and flushed* Skin is hot dry and flushed

* Severe poisoning causes disorientation, agitation, * Severe poisoning causes disorientation, agitation,

violent behaviour, visual and auditary hallucinations violent behaviour, visual and auditary hallucinations

convulsions, respiratory failure and coma.convulsions, respiratory failure and coma.

ATTANA / Thorn Apple ATTANA / Thorn Apple Contd…Contd…MANAGEMENTMANAGEMENT

Do gastric lavage when appropriate.Do gastric lavage when appropriate. Give activated charcoal when appropriate.Give activated charcoal when appropriate. Fits – Diazepam 5- 10 mg IVFits – Diazepam 5- 10 mg IV Check BU/SE, Blood gasCheck BU/SE, Blood gas Treat symtomatically where appropriate.Treat symtomatically where appropriate.

HABARALA DUMB-CANEHABARALA DUMB-CANE

HABARALAHABARALA(Alocasia macrorrhiza)(Alocasia macrorrhiza)

IdentificationIdentification Large herb with tunerous root. Large herb with tunerous root. Leaves are large and simple, no characteristic Leaves are large and simple, no characteristic

pattern.pattern. Toxic substance – Calcium oxalate crystals Toxic substance – Calcium oxalate crystals

and unidentified volatile compounds.and unidentified volatile compounds. Some other household decorative plants e.g Some other household decorative plants e.g

Dumb-cane and Caladium sp., also contains Dumb-cane and Caladium sp., also contains above toxic substances. above toxic substances.

HABARALA HABARALA Contd…Contd…

Signs & Sym.Signs & Sym.Initially profuse salivation, irritation, burning Initially profuse salivation, irritation, burning sensation and pain of the oral cavity following sensation and pain of the oral cavity following ingestion stalks of the plant.ingestion stalks of the plant.Later oedema of the tongue, lips, cheeks, salivary Later oedema of the tongue, lips, cheeks, salivary glands and throat lead to disphagia and aphonia.glands and throat lead to disphagia and aphonia.Ingestion of large amount lead to necrotic Ingestion of large amount lead to necrotic oesophagitis and haemorrhagic gastritis. Death may oesophagitis and haemorrhagic gastritis. Death may result from laryngeal oedema. result from laryngeal oedema. Bradycardia, tremos, muscle twitching and trismus, Bradycardia, tremos, muscle twitching and trismus, convulsions and acute renal failure also can occur.convulsions and acute renal failure also can occur.

HABARALA HABARALA Contd…Contd…

ManagementManagement

For severe pain – analgesics For severe pain – analgesics (parenteral (parenteral analgesics may necessary). analgesics may necessary).

To reduce the mouth irritation suck ice and milk.To reduce the mouth irritation suck ice and milk.

Respiratory obstruction – Intubation of tracheostomy.Respiratory obstruction – Intubation of tracheostomy.

Check renal function and SE/BU and Serum calcium.Check renal function and SE/BU and Serum calcium.

Maintain a fluid balance chart.Maintain a fluid balance chart.

Treat symptomatically where necessaryTreat symptomatically where necessary ..

KEPUNKIRIYAKEPUNKIRIYA (Euphorbia hirta)(Euphorbia hirta)

KEPUNKIRIYA KEPUNKIRIYA Contd…Contd…

IdentificationIdentificationHerb with an erect stout stem, covered with Herb with an erect stout stem, covered with bristly hair. Fruit is a capsule, hairy, 3 lobed, bristly hair. Fruit is a capsule, hairy, 3 lobed, each splitting ventrally and dorsally. Seeds-each splitting ventrally and dorsally. Seeds-avoid, wrinkled and reddish brown in colour.avoid, wrinkled and reddish brown in colour.Toxic substances – Alkaloid xanthoramine, Toxic substances – Alkaloid xanthoramine, gallic acid, phenolic substance etc.gallic acid, phenolic substance etc.Vegetative and reproductive organs – Vegetative and reproductive organs – hydrocyanic acid.hydrocyanic acid.

KEPUNKIRIYA KEPUNKIRIYA Contd…Contd…Signs and SymptomsSigns and Symptoms

Common symptoms are:Common symptoms are:

Nausea, vomiting, and drowsiness.Nausea, vomiting, and drowsiness.

Observe for cyanide poisoning featuresObserve for cyanide poisoning features

KEPUNKIRIYA KEPUNKIRIYA Contd…Contd…ManagementManagement

Check A, B, C.Check A, B, C. Give activated charcoal 50-100g in 200ml Give activated charcoal 50-100g in 200ml

1-2 hrs of ingestion.1-2 hrs of ingestion.

Treat symptomatically where necessaryTreat symptomatically where necessary

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