Plant Poisoning

Plant Poisoning is a topic covered in the 5-Minute Emergency Consult.

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Basics

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

Identification of ingested plant species should be attempted whenever possible.

Plants with Anticholinergic Properties
  • 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

Plants with Cardiac Glycosides
  • 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

Plants with Nicotine-like Alkaloids
  • 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

Plants with Cyanogenic Compounds
  • 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

Plants with Calcium Oxalate Crystals
  • 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.

Plants with Pyrrolizidine Alkaloids
  • 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.

Plants with Sodium Channel Activity
  • 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.

Plants with Toxalbumins
  • 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

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