Plant Toxicity. Introduction Frequency of Plant Exposure by Plant Type §Capsicum (pepper...
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Transcript of 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