Transcript CLOSE ENCOUNTERS OF THE BOTANICAL KIND

CLOSE ENCOUNTERS OF
THE BOTANICAL KIND
Donna Lotzer, RPh
Poison Education Coordinator
UW Hospital Poison Prevention Center
June 2015
Monkshood
Aconitum napellus
• Whole plant toxic, esp. roots
and leaves
• Leaves like parsley, roots
mistaken for horseradish/celery
• Ingestion causes local tingling,
burning, numbness, thirst
• N, V, D, visual changes follow
• Circulatory failure, cardiac
arrhythmias lead to fatalities
• Fatal cases resulted 1½ to 8
hours post ingestion, most with
cardiac cause of death
• Management in ICU if get there
Monkshood
Alternate names include friar’s
cap, old wife’s hood, helmet
flower (easy to see why!)
Poison Ivy
Toxicodendron radicans
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One of most UNpopular plants
Reaction is dual with allergic rxn too
Sap is culprit, found in entire plant
Skin contact causes symptoms
of redness, itching, blisters
“progressing” over time
• Management:
• Wash affected area well
• Domeboro®, rubbing alcohol,
steroid cream
• Protect blisters, keep clean
• Oral antihistamines/steroids
• Launder clothing separately
Poison Ivy
Poison
Sumac
Toxicodendron
vernix
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Water Hemlock
Cicuta maculata
• Very highly toxic to fatal plant
• Mistaken for other edible plants
(smells like parsnip)
• Symptoms occur in 15-60 min.
and include N, V, D, severe
abdominal pain, dilated pupils,
violent muscle spasms,
seizures, respiratory paralysis
• Person may not survive till
medical care can be provided
• Folk antidote of salmon oil
skimmed off salmonhead
soup!!
Water Hemlock
Folk names of beaver
poison, death-of-man,
children’s bane (HINT!)
Poison Hemlock
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Conium maculatum
Highly toxic plant, common
• Fatal peds cases mistook ID
in WI marshes, ditches
• Socrates killed with this
Mistaken for carrot, parsnip
plant in liquid prep at 70 !
Roots and seeds esp. toxic
• Skin contact causes a
dermatitis reaction
Symptoms (1-3 hours) like
nicotine and include
irritation, salivation, tremors,
dilated pupils, muscle spasm,
seizures, paralysis
Death due to respiratory
failure
Management is seizure and
respiratory support, observe
4 hours if no symptoms.
Poison Hemlock
Also known as kill cow, poison
parsley, spotted hemlock
Wild Parsnip
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Pastinaca sativa
Ditch weed, fields, RR tracks • Burns appear streaky from sap
Dermal toxicity dominates
• Mistaken for poison ivy
No sun – irritation and rash
• Management:
Sun-induced burns
• Cover up skin
• Psoralens are culprit
• Domeboro®, steroid cream
Mild: red, sunburn look
• Protect blisters, keep clean
Moderate: blisters form, area
looks scalded (Day 1-3)
Sweat enhances reaction
Delayed: Blisters rupture,
red-brown hyperpigmentation
lasting up to 2 years!
Wild
Parsnip
Queen Anne’s Lace
Daucus carota
• Commonly referred to as
wild carrot
• Compare look to hemlock!!
• Toxic because of dermal
irritation from sap, combined
with sunlight (like parsnip).
• Some parts are potentially
edible so must be sure of ID.
• Management for dermal
exposure is repeated
washing and sun avoidance
Wild Plant Guessing Game
IS THIS PLANT…
Wild Carrot ?
Wild Parsnip ?
Poison Hemlock ?
WOULD YOU EAT IT TO FIND
OUT THE RESULTS?
The Poison Center phone number
is 1-800-222-1222 !!!!
Visual ID Help
• The Umbellifer Family:
The parsnip is on the
bottom; left to right:
Italian Parsley, Parsley
Root "Hamburg
Parsley", Red Carrot ,
Chanteney Carrot,
Yellow Carrot , White
root poison hemlock,
Yellow root poison
hemlock, Fennels.
Tasty or toxic?
• Parsnip root (top) and hemlock root (bottom)
Foxglove
Digitalis purpurea
• Active principle is digitalis, used
since 1700’s in medical practice
• “Mistaken ID” leads to ingestion
and some poisonings
• Symptoms include nausea,
visual changes, slow irregular
pulse, tremors, seizures
• Management includes medical
observation for 12 hours, with
ICU if sxs develop, with pacer,
atropine, ? Fab fragments?
Foxglove
Common names include fairy
bells, witches’ thimble, rabbit
flower, lion’s mouth
Lily of the Valley
Convallaria majalis
• Plant contains convallarin,
convallotoxin, convallamarin
(digitalis-like compounds)
• Multiple options for
ingestion by kids/adults
• Symptoms like foxglove
• Management like foxglove
Lily of the Valley
Castor Bean Plant
Ricinus communis
• Grown as an ornamental in WI
• Beans common in imported
jewelry
• Ricin – poison for spy stories and
bioterrorism concerns
• One of most potent natural toxins
(also contains ricinus)
• If chewed, expect burning of
mouth and throat, N, V, D,
sweats, seizures and death
• Management in ICU for kidney,
respiratory and circulatory failure
from ingestion or injection
Castor Bean Plant
Jimsonweed
Datura stramonium
• Good-looking, ill-smelling weed
• Poisoning from honey, making
tea, eating seeds or leaves
• Abusable by ingestion, smoking
• “Good” symptom=hallucinations
• “Bad” symptoms=flushed & dry
skin/mouth, dilated pupils, high
pulse, fever, delirium, seizures
• Symptoms may last 12-48 hours
• Management is to monitor body
temp and mental status, give
physostigmine for severe cases
Jimsonweed
Also called mad apple,
Devil’s trumpet, stink weed
(Close relative is
Angel’s trumpet)
Lupine
Lupinus spp.
• Member of the legume family
• Forms seed pods like peas
• Contains multiple toxins under
variable conditions
• Seed pods and leaves/stems
most toxic in spring
• Symptoms include nausea,
abdominal pain, slowed
breathing, death (rare)
• Management is
supportive care
Tobacco
Nicotiana tabacum
• Garden ornamental or grown for
smoking tobacco in WI
• Whole plant is toxic, usually ingestion
or dermal exposures cause problems
• Harvest time leads to occupational
exposures
• Symptoms include salivation,
vomiting, pulse and BP changes,
seizures, respiratory failure
• Management is topical
decontamination, supportive care,
atropine possibly in severe cases
Indian Tobacco
Lobelia inflata
Thomas G. Barnes @ USDA-NRCS PLANTS Database
Barnes, T.G. & S.W. Francis. 2004.
• Common names include
pukeweed, gagroot, vomitroot
• Has respiratory stimulant,
antispasmodic and relaxant
properties
• Native Americans
smoked/chewed for lung
diseases (asthma, bronchitis)
• Toxicity includes vomiting,
seizures, respiratory failure
from muscular paralysis (like
curare!) and death
• Management is in ICU
• Once found in stop-smoking
products to help with nicotine
withdrawal sxs
Indian Tobacco
Cardinal Flower
Found
along WI
river
banks
Yew
Taxus spp.
• Several varieties, all toxic
• Foliage will kill cows, horses
• Seeds commonly ingested by
children
• Symptoms include vomiting,
dizziness, dilated pupils, slow
pulse, seizures, coma and
rarely death
• Management ranges from
observation to support in an
ICU setting (rare)
Milkweed
Asclepius spp.
• Food source for Monarch
butterflies
• Selected varieties edible young
• Toxic part is white latex (sap)
found inside entire plant
• Mixed toxic chemicals found
• Topical exposure can cause
dermatitis
• Management is washing
• Folk medicines use milkweed
• Animals poisoned by ingestion
Milkweed
Skunk Cabbage
Symplocarpus foetidus
• Called polecat weed
because of odor
• Toxic chemical is calcium
oxalate
• Symptoms are mouth pain
and swelling if ingested
• Management is supportive
care (ice cream works
well)
• Claims for edibility, but…
William S. Justice @ USDA-NRCS PLANTS Database
Jack-in-the-pulpit
Arisaema spp.
• Cultivated or wild woodland
plant, attractive fruits
• Toxic chemical is
calcium oxalate
• Symptoms are localized
painful burning and swelling
of mouth, throat and tongue
• Management includes ice
cream, milk or any cool liquid
• Seeds mistaken for
pomegranate!
Jack-in-the-pulpit
Fruiting bodies (seed head)
Mayapple
Podophyllum peltatum
• Common woodland plant
• Ripe fruit possibly edible but
stay away from the rest !
• Symptoms of ingestion are
GI (explosive diarrhea)
• Systemic liver and kidney
damage possible, mutagen
• Management is antiemetics
and supportive care
Nightshade
Solanum spp.
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NOT “DEADLY” plant
Vine, relative of tomatoes
Attractive but inedible weed
Several common variations, bad
reputation exaggerated
• Symptoms potentially could
include vomiting, weakness
• Management is generally not
needed, but would be basic care
Climbing
Nightshade
Nightshade
Black Nightshade
(fruit turns black
when ripe)
Baneberry
Actea rubra
• Toxic woodland plant with
unidentified chemicals
• Symptoms include mouth
burning and swelling,
headache, abdominal pain,
salivation
• Management is supportive
• Used historically in Native
American medicine
Baneberry
Commonly known as doll’s eyes
or snakeberry
Bloodroot
Sanguinaria canadensis
• Member of the poppy family
• Named for red-orange juice in
roots and stems
• Most toxic part is roots
• Multiple toxic compounds
• Symptoms include vomiting,
dizziness, fainting, dilated
pupils (in theory)
• Management is supportive
Stinging
Nettle
Urtica dioica
• Weed found in open areas
• Some sources say edible,
BUT…
• Toxicity: painful burning
dermatitis upon contact
• Management is supportive
with hot water to wash
skin, steroid cream and oral
antihistamines
Virginia Creeper
Parthenocissus quinquefolia
• Common cultivated woody
vine on buildings or a weed in
woods wrapped around trees
• Toxic chemical is calcium
oxalate in fruit, sap
• Symptoms of local irritation
expected dermally and orally
• Management is washing skin,
ice cream, milk or any cool
liquid
Burdock
Arctium minus
• Commonly mistaken for
rhubarb when young
• Leaves are “fuzzy” and stems
inedible but not toxic
• Burs cause mechanical injury
• Management not required
unless for stuck burs
• Very popular herbal preps
from root, seeds
Elderberry
Sambucus spp.
• Flowers and fruits used
to make wine, jelly
• Potential toxicity of
fruit, leaves, bark, roots
• Symptoms including
vomiting, diarrhea
• Native Americans used
stems, leaves and roots
as emetic and cathartic
agents
• Management is
supportive care
Oak acorns
Quercus spp.
• Essential food for wild critters,
not humans
• Contains bitter tannins
• Symptoms not expected
• Management usually not
needed
• Foliage can be toxic to animals
Bracken Fern
Pteridium aquilinum
• Reputation as edible but
numerous toxic compounds
including cyanide,
carcinogens
• Linked to stomach cancer
in Japan
• Fiddleheads most likely to be
consumed by humans,
animals
• Acute toxic effects not
generally expected
• Recipes say to cook 20
minutes (unknown if this
eliminates toxins)
For More Information
• This presentation is on the web at
www.uwhealth.org/poison
– Look under educational materials
• Common Plants – What’s Poisonous and What’s Not
– Also on my web page
• http://plants.usda.gov/index.html is an excellent
reference and used for selected pictures in this
presentation