Plant Toxins – Phyto Toxins

Dr. Sarah SubhashiniDepartment of General Medicine

CHRI

Overview

Common plants which are toxic

Symptoms of toxicity

Treatment

Castor plant

CASTOR OIL PLANTThis poisoning is often seen in children, who eat the seeds

of the plant by mistake.Symptoms

There is pain in the abdomen associated with nausea, severe vomiting and burning pain in the throat.

There may be diarrhoea with blood in the stools, dehydration, a rapid feeble pulse, cold clammy skin, cramps and prostration.

Collapse and death usually follow. About ten castor oil seeds are considered a fatal dose.

TreatmentThe stomach is washed out and stimulants are administered, together with an injection of morphine (15 mg) only if there is no shock.

Intravenous glucose saline is given for dehydration, and potassium must be supplemented

ABRUS PRECATORIUS

ABRUS PRECATORIUSThe small, 8 mm x 6 mm, scarlet coloured, egg-

shaped seeds of the plant, with black dot at one end, are used by goldsmiths in India for weighing.

SymptomsThere is vertigo, fainting, vomiting, dyspnoea,

general prostration with cold extremities. The pulse becomes fast and irregular,

convulsions may develop, and death follows from cardiac failure within 3 to 5 days.

Treatment

Treatment is by removal of the ingested beans by emesis or gastric lavage, and by alkalinising the urine by giving 5-15 g of sodium bicarbonate daily to prevent precipitation of haemoglobin and haemoglobin products in the kidneys.

Convulsions are controlled with diazepam.

Intravenous fluids are given for dehydration

Cannabis sativa

CANNABIS SATIVA OR INDICA (Indian hemp)

This grows all over India yields a resin, cannabinone, containing an oily liquid called

cannabinol, cannabidiol, cannabinolic acid and several tetrahydro cannabinol isomers.

In India, it is used as :(a) Bhang, an infusion made from dried leaves and fruiting shoots

and then mixed with sugar and water to prepare an intoxicating drink;

(b) Majun, a confection prepared from bhang, sugar, flour, milk and butter. Four to 12 g of the material is enough to produce intoxication;

(c) Ganja, the flowering or fruiting tops of the female plant, coated with resin, smoked in a chilam (pipe), mixed with some tobacco. The American hemp plant is used in cigarettes called "reefers" or "pot", increasingly used by teenagers in America and England;

(d) Hashish, the dark green or brown resin of the plant smoked with tobacco. It is most potent as an intoxicant.

SymptomsAcute poisoning : There is a stage of inebriation,

followed by a stage of narcosis, produced after smoking or taking the drug internally. Symptoms vary according to the dose and personality of the user.

At first, there is excitement with visual hallucinations, euphoria, laughter and marked increase of appetite.

There is disorientation, and the person gets frightful hallucinations, becomes wildly delirious and may display homicidal tendencies.

He feels giddy, ataxic, complains of tingling and numbness, becomes drowsy and then passes on to the stage of narcosis, with dilated pupils and deep sleep.

There may be generalised anaesthesia in case of severe poisoning. Recovery usually follows a deep sleep of several hours. Rarely, death occurs due to respiratory failure.

Chronic poisoning results from prolonged use. The symptoms are loss of appetite, general weakness, tremors, loss of sexual power, moral and mental deterioration, and on rare occasions, psychotic features.

TreatmentThe stomach is evacuated and the patient

treated symptomatically. Diazepam 0.1 mg/kg orally helps to control excitement and convulsions.

Datura fastuosa

DATURA FASTUOUSA (Dhatura)

There are two varieties of datura Seeds and fruits are the most poisonous parts of the plantHyoscine, Hyoscyamin and traces of atropine are the active

principles.

SymptomsWithin half an hour of taking the poison, gastric irritation

starts. The patient complains of a bitter taste, dry mouth and throat, burning pain in the stomach and difficulty in swallowing and talking.

This is followed by giddiness, ataxia, inco-ordination of muscles, a peculiar flushed appearance of the face, dry hot skin, rise in temperature, diplopia, dilated pupils with loss of accommodation, reddening of the conjunctiva and drowsiness.

Sometimes, an erythematous rash appears all over the body. There is usually a full, bounding pulse, which later becomes weak and irregular. The patient develops muttering delirium, tries to run away from the bed, picks at bed clothes, tries to pull imaginary threads from the tips of his fingers and develops dreadful hallucinations of sight and hearing.

The condition may pass on to stupor, convulsions, coma, and sometimes death from respiratory failure.

Although the fatal dose and fatal period vary, a decoction of 125 datura seeds has proved fatal. Death may occur within 4 to 24 hours

DATURA FASTUOUSA (Dhatura)

TreatmentThe stomach is washed out with 1:10,000

potassium permanganate solution or 5 per cent tannic acid solution.

Neostigmine 0.5 mg is injected subcutaneously. Pilocarpine nitrate (6 to 15 mg) or

methacholine may be given subcutaneously, and may need to be repeated.

For delirium, chloral hydrate, paraldehyde or any short-acting barbiturate is usually given.

Morphine, which depresses the respiratory centre, must not be given.

Nerium odorum (oleander)

NERIUM ODORUM (Pink oleander, arali)

The plant is commonly grown in the gardens of India for its beautiful flowers.

A glycoside (nerin) has been isolated from it. The root has been employed criminally as an abortifacient. The roots and leaves have also been used for suicidal purposes in western and southern India and rarely as homicidal poisons or cattle poisons.

SymptomsThese are difficulty in speaking, dysphagia, pain in the

abdomen, vomiting, excessive frothy salivation, diarrhoea, fast respiration, weak rapid pulse, dilated pupils, muscular twitchings, tetanic spasms, drowsiness and finally, coma and death. At times, there are manifestations of "lock-jaw" or tetanus. About 16 g of the powdered root usually causes death within 24 to 36 hours.

TreatmentThe stomach is washed out and symptomatic treatment is given.

Cerebra thevetia (yellow oleander)

CEREBRA THEVETIA (Cerebrum odallum, Yellow oleander or Pila kaner)

This is an ornamental plant that is grown for its yellow bell-shaped flowers in the gardens of India.

Its milky juice contains two highly poisonous glycosides, thevetin and cerebrin. The roots and seeds are used as abortifacients, for suicidal and homicidal purposes and also as cattle poisons.

SymptomsThese include dryness of the throat, burning pain

in the mouth, tingling and numbness of the tongue, vomiting, diarrhoea, dizziness, dilated pupils, muscular weakness, tetanic convulsions, fainting, a fast, weak and irregular pulse, and later, collapse and death from circulatory failure. Heart block is a prominent finding.

TreatmentThe stomach is emptied and the

condition treated symptomatically. 1.2 mg of atropine or orciprenaline (1-2

mg) parenterally are given for heart block.

Pacemaker insertion may be required

Oduvanthalai poisoning

Cleistanthus collinus, a toxic shrub, is used for deliberate self-harm in rural South India.

The toxic principles in the leaf include arylnaphthalene lignan lactones — Diphyllin and its glycoside derivatives Cleistanthin A and B.

Results in renal tubular dysfunction, commonly dRTA, with resultant hypokalemia and normal anion gap metabolic acidosis.

Acute respiratory distress syndrome (ARDS) is seen in severe cases.

Cardiac rhythm abnormalities have been demonstrated

Consumption of decoctions of C. collinus leaves, causes hypokalemia, renal failure, severe metabolic acidosis, ARDS and cardiac arrhythmias.

Treatment is mainly supportive.No specific antidote.Cardiac pacemaker may be required for life

threatening arrhythmias.

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