Plant poisoning

Introduction

• Mostly asymptomatic or cause minor irritative symptoms only
• Calcium oxalate crystals can cause more severe irritation if exposed to mucous membranes
  • Needle-like crystals packaged into bundles that can cause mechanical injury to mucosal surfaces when ingested
• Hospital assessment only required in children if symptoms develop

Categories

• Vine-creeper
• Date palm-like
• Grass
• Herb
• Shrub tree
• Succulent-cacti

Vine-creeper

• Asparagus fern – Musocal irritation
• Brazilian nightshade – GI irritation, nausea and diarrhoea
• Chalice vine – Nausea, vomiting, diarrhoea, headache, mydriasis, fever, delirium
• Crab’s eye
• Fruit salad plant – Calcium oxalate irritation
• Glory lily
• Japanese honeysuckle – Non-toxic
• Pothos – Calcium oxalate
• Raphidophora – Irritant
• Wild passionfruit– Nausea if unripe
• Wisteria – Burning mouth, abdo pain, nausea, vomiting and diarrhoea

Date palm-like

• Burrawang palm
• Cycads
• Fishtail palm – Calcium oxalate
• Pineapple zamia – Same as cycads
• Zamia – Same as cycads
• Zanzibar gem – Irritation

Grass

• Agapanthus – GI upset and irritation
• Blue flax lily – Berries might cause dyspnea, hiccups, dizziness
• Daffodil – GI upset
• Hippeastrum – GI upset

Herb

• Angel’s wings – Mucosal burning and GI upset
• Arrow head plant – Calcium oxalate
• Arum lily
• Asparagus fern – Non-toxic
• Blackberry nightshade – Headache, mild GI upset
• Chilli
• Comfrey
• Common thornapple
• Cunjevoi – Mucosal burning/swelling
• Dumbcane

Herb

• Flamingo flower – Blistering/swelling/burning
• Foxglove
• Hairy thornapple – Same as common thornapple
• Iris tectorum
• Lantana
• Peace lily – Tingling/burning
• Periwinkle
• Peruvian lily
• Petty spurge
• Philodendron – Calcium oxalate
• Primula – Irritant

herb

• Rhubarb – Calcium oxalate if uncooked
• Snow on the mountain – Corrosive sap
• Stinging nettle – Burning/itch up to 36 hours
• Sweet pea – Paralytic syndrome if ingested for weeks regularly
• Taro – Irritation
• Tobacco – Nicotinic reaction

Shrub-tree

• African milk bush – Irritation
• Angel’s trumpet
• Bellyache bush
• Black bean – Seeds can cause severe GI upset
• Brazilian pepper tree
• Bush allamanda
• Candle nut – Raw kernel can cause abdominal cramps, severe GI upset
• Castor oil plant
• Chenille plant
• Codiaeum
• Copperleaf
• Coral plant

Shrub-tree

• Crown of thorns
• Desert rose
• Duranta
• Frangipani
• Green cestrum
• Grevillea
• Guatemala rhubarb
• Hydrangea
• Inkweed
• Jerusalem cherry

Shrub-tree

• Mango
• Milky mangrove
• Naked lady
• Night blooming jasmine
• Pepperina
• Physic nut
• Pink oleander
• Plumbago
• Poinsettia
• Pokeweed
• Pride of Madiera
• Privet

Shrub-tree

• Rhus – Severe allergic dermatitis
• Sea mango
• Silky oak
• Snowflake
• Stinging tree
• White cedar
• Wintersweet
• Yellow allamanda
• Yellow oleander
• Yesterday, today and tomorrow
• Zigzag plant

Succulent-cacti

• Candelabra cactus

Crab’s eye

• Abrus precatorius subsp. Africanus
• Chewed or broken seeds are potentially fatal
• One seed contains enough poison to kill adult
• Nausea, vomiting, severe diarrhea, disorientation and
  death
• Rapid onset or delayed 1-3 days

Glory lily

• Numbness to lips/tongue
• Nausea, vomiting, abdo pain after 2-12 hours
• Tachycardia and chest pain
• Seizures, bone marrow failure and death
  have occurred

Burrawang palm

• Raw fruit can cause GI irritation, abdo cramps,
  vomiting and diarrhea
• Liver damage and paralysis in severe cases

cycads

• Raw fruit can cause headache and severe GI upset
• In severe cases, liver damage, coma and death

Arum lily

• Swelling of tongue and throat
• Stomach pain, vomiting and diarrhea
• GI upset can be life-threatening

comfrey

• Delayed liver damage
• Repeated exposure can cause liver failure
• Death has been reported

Common thornapple

• Intense thirst, dry mouth, vomiting, diarrhea, fever
• Confusion, delirum, mydriasis, seizures and coma
• Deaths have occurred
• Eye contact with sap can cause mydriasis and
  temporary blindness

dumbcane

• Copious salivation and intense burning sensation
• Swelling of mucosa
• Difficulty breathing/speaking

foxglove

• Digitalis toxicity
• Nausea, diarrhea, abdominal pain
• Slow AF
• Tiredness
• Dizziness

lantana

• Berries poisonous
• Delayed onset nausea, vomiting, diarrhea,
  dyspnea, mydriasis, lethargy, weakness

Angel’s trumpet

• Intense thirst, vomiting, diarrhea
• Fever, confusion
• Mydriasis
• Delirium
• Seizures
• Coma

Bellyache bush

• Delayed onset (hours) abdominal pain, burning
  sensation in throat, nausea, vomiting, diarrhea
• Dehydration and GI bleeding
• Flushed skin, mydriasis, tachycardia

Castor oil plant

• Seeds can cause irritation to mouth
• Severe GI upset
• Can be delayed onset
• Liver damage and life-threatening potentially

Coral plant

• Fruit can cause GI upset, numbness and paralysis
• Anticholinergic effect

Desert rose

• Bradycardia, hypotension
• Lethargy, dizziness, GI upset

Green cestrum

• Fever, tachycardia
• Salivation
• Gastritis

Jerusalem cherry

• Unripe fruit especially can be fatal
• Fever, sweating, vomiting, headache,
  tachycardia
• Symptoms can be delayed and can persist
  for days

Naked lady

• Sap is highly irritant to skin/eyes
• Sap if ingested can cause burning of lips,
  tongue, mouth, vomiting and death recorded

Night blooming jasmine

• Fever, tachycardia, salivation and gastritis

Physic nut

• Seeds poisonous
• Acute abdominal pain and burning to throat
• Followed by vomiting/diarrhea
• Flushed skin, mydriasis, dry skin and tachycardia

Pink oleander

• Nausea, vomiting, lethargy, abdo pain and dizziness
• Bradycardia, seizures and coma

pokeweed

• Headache, severe GI upset
• Intense vomiting
• Foamy diarrhea
• Symptoms up to 48 hours
• Especially toxic to children

Pride of madiera

• Usually in herbal remedies
• Delayed days to weeks — >Acute liver disease,
  gastroenteritis, Hepatosplenomegaly, abdo
  pain, vomiting and diarrhoea

Sea mango

• Vomiting
• Diarrhoea
• Bradycardia
• Drowsiness

White cedar

• Nausea
• Vomiting
• Diarrhoea
• Lethargy/confusion
• Coma
• Seizure
• Death
• Symptoms can be delayed several hours

wintersweet

• Lethargy, restlessness, seizures
• GI irritation, salivation, vomiting

Yellow oleander

• Several deaths in children reported
• Burning sensation to mouth
• Vomiting, diarrhea
• Bradycardia

Yesterday, today and tomorrow
 – Brunfelsia

• Salivation
• Vomiting, diarrhea
• Nervous excitement, tremor
• Hallucinations
• Delirium
• Seizures

Specific toxins

• Aconite
• Belladonna alkaloids
• Cardiac glycosides
• Tobacco
• Coniine
• Colchicine
• Amygdalin
• Hypoglycin A
• Psychotropic alkaloids
• Ricin
• Taxine

aconite

• Severe CVS, PNS/CNS and GI toxicity. High mortality from ventricular dysrhythmia and CV collapse
• Found in some Asian herbal medicines
• Binds to voltage-dependent sodium channels leading to permanent activation of cardiac muscle and voltage-dependent nerve tissue receptors
• Dose-dependent toxicity occurs rapidly

Belladonna alkaloids

• Atropine, Scopolamine, Hyoscine amine alkaloids
  • Competitive blockade of central and peripheral acetylcholine muscarinic receptors leading to anticholinergic syndrome
  • Found in belladonna (Atropa spp.), angel’s trumpet (Datura spp.) and henbane (Hyoscyamus spp.)

Cardiac glycosides

• Found in foxglove (Digitalis purpurea), pinke and white oleander (Nerium spp.) and yellow oleander (Thevetia spp.)

Plant toxins

• Colchicine
  • Antimitotic agent found in Autumn crocus (Colchicum autumnale) and glory lily (Gloriosa superba)
• Coniine
  • Alkaloid found in poison hemlock (Conium maculatum)
  • Structurally related to nicotine and can cause neuromuscular blockade and respiratory failure
• Amygdalin
  • Cyanogenic glycoside found in seeds or pits of apricots, almonds, apples, peaches and wild cherries
  • Laetrile is marketed as a health food
• Hypoglycin A
  • Found in seeds of Ackee tree and causes hypoglycaemia, CNS depression and seizures

Plant toxins

• Nicotine
  • Tobacco causing tachycardia, hypotension, tremor, sweating, GI upset and seizures
• Psychotropic alkaloids
  • Lysergic acid (Morning glory seeds) and mescaline (peyote Cactus)
• Ricin
  • Lectin found in castor bean plant and crab’s eye berry causing inhibition of intracellular protein synthesis, severe GI upset and multiorgan failure
• Taxine
  • Mixture of alkaloids found in Yew trees which inhibits sodium and calcium currents leading to GI upset, paraesthesia, ALOC, bradycardia, conduction blocks, ventricular dysrhythmias and cardiac arrest

management

• Resuscitation unlikely to be required except in Aconite poisoning in which death may occur within hours
• Activated charcoal should be considered
• Skin exposure requires thorough washing/irrigation
• Antidotes
  • Physostigmine for severe anticholinergic syndrome
  • Cyanide antidotes for cyanogenic glycoside poisoning
  • Digibind for cardiac glycoside poisoning

Last Updated on October 13, 2020 by Andrew Crofton