Transcript Toxicology

Plant Toxicity
Introduction
Frequency of Plant Exposure by Plant Type
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Capsicum (pepper plant)(5374 exposures)
Philodendron (4061)
Holly (3441)
Euphorbia sp. (poinsettia) (3296)
Dieffenbachia (dumbcane) (2141)
Non Toxic Plants
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African violet
Boston fern
Coleus
Crab apple
Dandelion
Hibiscus
Magnolia
Petunia
Snake plant
Begonia
Christmas cactus
Corn plant
Daisies
Easter Lilly
Jade plant
Marigold
Prayer 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 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
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 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
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
Common Poisonous Plants
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
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)
Caladium
Dumbcane
Split leafed
Philodendron
Christmas plants
 American Holly
 Mistletoe
 Poinsettia
American Holly
 Berries are toxic, contain Ilicin
 Clinical signs
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Nausea, severe vomiting, abdominal pain,
diarrhea
 Treatment - Ipecac, activated charcoal
Jerusalem
Cherry
Mistletoe
 Berries are toxic , contain B-phenylethylamine
and tyramine
 Clinical signs
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acute gastroenteritis, cardiovascular collapse,
nausea, vomiting, respiratory difficulty, delirium,
hallucinations, death
 Treatment - Ipecac, activated charcoal, transport
Poinsettia
 Non toxic
 contains a latex sap which can be
slightly irritating to mucous
membranes
 Treatment - give demulcents
Poinsettia
Cardiotoxic Plants
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Contain cardiac glycosides
Oleander
Azaleas
Lilly 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 ornamental
 Clinical signs
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GIT irritation, vomiting, abdominal pain,
diarrhea, hyperkalemia, AV block, cardiogenic
shock
 Treatment - Ipecac, activated charcoal,
transport
Oleander
Oleander
Oleander
Azaleas
 Rhododendron, Bird of paradise
 contain andromedotoxin
 Treatment - Ipecac, activated charcoal,
transport
Azaleas
Azaleas
Castor Bean
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
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nausea, violent vomiting and diarrhea, burning
sensation in the mouth, hemolysis, renal failure,
death
 Treatment - Ipecac, activated charcoal, transport
Castor
bean
Castor
Bean
Castor
Bean
Rhubarb
Rhubarb
 Leaves are toxic, contain oxalic acid, heating
does not destroy the toxic principle
 Stems are edible
 Clinical signs
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abdominal pain, vomiting, diarrhea, headache,
muscle cramps, tetany, renal failure
 Treatment - Ipecac, activated charcoal, transport
Rhubarb
Rhubarb, stem
Rhubarb
Rhubarb,
flowers
Jimsonweed
Datura stramonium
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
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
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
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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, pigeonberry
 Roots and leaves are the most toxic, fruit is
mildly toxic
 Toxic principle is a resinous material and a
water soluble saponin
Poke weed
 Clinical signs
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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 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
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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:
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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.
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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.
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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:
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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 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
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
Categories of Mushroom Toxicity
 I) Protoplasmic poisons - destruction of cells
 Signs and Symptoms
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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:
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phalloidin
phalloin
amatoxin - accounts for the lethality
Amanita phalloides
Amanita phalloides
Categories of Mushroom Toxicity, cont.
 II) Neurotoxins
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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
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cause nausea, vomiting, abdominal cramping,
diarrhea
 Examples: green gill, gray pink gill, etc.
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.
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
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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
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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