Plant Poisoning

Description

• Plant exposure is 1 of the most common reasons to contact the poison center
• Majority of cases involve unintentional ingestion in children <6 yr old.

Etiology

• Genera include Atropa, Datura, Hyoscyamus, Solandra, and Solanum.
• Common names of anticholinergic plants include Jimson weed, deadly nightshade, henbane, and angel trumpet.
• Competitive antagonists of acetylcholine at the muscarinic acetylcholine receptor

• Genera include Digitalis, Nerium, Thevetia, and Helleborus.
• Common names of cardiac glycoside plants include foxglove, oleander, yellow oleander, lily of the valley, and hellebore/Christmas rose
• Inhibit Na⁺/K⁺-ATPase:
  • See separate chapter on Digoxin Poisoning

• Genera include Nicotiana, Caulophyllum, and Conium
• Common names of plants containing nicotine include tobacco, blue cohosh, and poison hemlock.
• Direct-acting agonists at the nicotinic acetylcholine receptor

• Genera include Hydrangea, Malus, Prunus, Sambucus
• Common names of plants containing cyanogenic compounds (in some part of the plant) include apricot, cherry, peach, plum, apple, cassava, and elderberry
• Metabolized to cyanide, which interferes with electron transport chain and leads to cellular poisoning

• Genera include Alocasia, Dieffenbachia, and Philodendron as well as many others
• Common names for calcium oxalate–containing plants include elephant's ear, dumb cane, and mother-in-law's tongue
• Clinical manifestations occur after release of intracellular calcium oxalate crystals:
  • Local tissue exposure to calcium oxalate crystals leads to inflammatory response.

• Genera include Crotalaria, Heliotropium, Senecio, and Sesbania
• Common names of plants with pyrrolizidine alkaloids include scorpion's tail, ragwort, groundsel, and rattlebox
• Metabolized to highly reactive pyrroles, which are directly hepatotoxic acutely and lead to hepatic vascular proliferation and veno-occlusive disease chronically.

• Genera include Aconitum, Delphinium, Leucothoe, Lyonia, Pernettya, Pieris, Rhododendron, Schoenocaulon, Veratrum, and Zigadenus
• Common names of plants with aconitine, veratrum alkaloids, and zygacine, all sodium channel openers, include: Aconite (monkshood, wolfsbane, delphinium), veratrum (false hellebore), and zygacine (death camas)
• Common names of plants with grayanotoxins, which have variable effects on sodium channels, include sweet bells, rhododendron, azalea, and lily-of-the-valley bush
• Variable sodium channel effects depending on toxin, although most lead to prolonged sodium channel influx.

• Genera include Abrus, Jatropha, Phoradendron, Ricinus, Robinia, Wisteria
• Common names of plants with toxalbumins include rosary pea, mistletoe, and castor bean
• Cause direct cellular toxicity by interfering with ribosomal function