Plant Poisonings ================ 1. Most plants are non-toxic or only slightly toxic; only a few are deadly. 2. Plant ingestions form 10% of ingestions reported to poison centers. 3. Use AMA poisonous plants book as a reference (small, cheap). 4. Ellenhorn's book is good encyclopedic reference. 5. Most exposures in age group less than 6 years, but also in pets. 4. Hunt institute at CMU will ID plants (and mushrooms) 24 hrs. a day; contact through poison center. 5. Seasonal variation; e.g., if September and mom says kid ate honeysuckle berries, more likely to be nightshade (honeysuckle fruits earlier). 6. Most outcomes good (only 1 fatality reported last year). GENERAL QUESTIONS to ask Is the person symptomatic? Anatomic part ingested? E.g., tomato plant: green tomatoes always nontoxic, but green plant parts are toxic. Green potato plants also toxic. (Solenine) Fruit maturity? E.g. Jerusalem cherry - green fruit more toxic. Has it been cooked? E.g., diffenbachia plant detoxified by boiling but not by baking. GENERAL TREATMENT Roses, petunias, begonias, nontoxic Chrysanthemums: have pyrethrins that repel bugs but mostly nontoxic. Honeysuckle berries in June and July, orange, juicy, nontoxic Mountain ash: small orange berries, ferment and make birds drunk; nontoxic. Oxalate containing plants: Arum plants, including diffenbachia (dumbcane, mother-in-law plant: prbably based on tropical varieties that have stronger idioblasts), and caladium and philodendron plants have idioblasts with oxolate crystals and proteolytic enzymes that rupture when crushed. Study by Pgh poison center of 200 exposures shows no problems or even any irritation. Most common plant ingestion. Clean out mouth, drink water, call back if problems. Jack-in-the-pulpit. Much soluble oxolate. Blooms late spring, then shiny red berries. Hot mouth, GI irritation. No serious problems from the cultivated plants. Virginia creeper: soluble oxolate. No serious problems. Rhubarb: has soluble oxolate, and may cause renal failure in animals, but not a problem in humans unless MASSIVE long exposure. Rhubarb edible throughout the season, but large raw ingestions may cause GI upset. Poinsetta: slight GI irritation, slight dermatitis. No serious problems. Hyacinth, Daffodil, Iris: some slight irritation from bulbs or tubers, but no significant injury. Holly berries: direct GI irritation. Not as bad if swallowed whole. May have GI irritation, vomiting, diarrhea, and GI bleeding if chewed up; may want to use ipecac, but charcoal not likely to help. Thirty to forty reported to cause death, but in older literature. Mistletoe: American variety (3-5 berries causes no problems) vs. European variety (very toxic). As few as 12 (European) berries brewed in tea has been fatal. European is carditoxic, American causes GI toxicity. Toxalbumin: third most toxic substance known. Castor plants. Ricin containing beans. Tremendous GI irritation and hemolysis. If chewed, would treat agressively with charcoal, lavage, bowel irrigation. Cardiotoxic: foxglove - very variable concentration of cardiac glycosides. Also found in lily-of-valley (strong emetic effect usually corrects; also water plants sit in can cause toxicity). Can do dig levels, but you're only testing for one or two of the many glycosides. Oleander - many colors, red flowers most toxic. Also reports of poisoning from oleander honey, and from roasting weenies on oleander sticks. Fab fragments seems to work. Rhododendron and azalea - several glycosides, but not similar to digoxin. Can cause hypotension and AV block. Cyanogenic plants: all Prunus seeds have amygdalin (laetrile). When broken down by hydrolysis in stomach, releases cyanide; not hydrolyzed when injected. Apple, peach, plum, apricot, cherry. Hydrangea - cyanogenic materials, fatalities in cattle grazing on them. Solanine: purple flowers with yellow stamens. Potent GI irritant, anti-cholinergic effects, fever, ?cardiac depressants nightshades (climbing nightshade; all degrees of fruit maturity on single vine; green is worst.) Potato sprouts, tomato. Jerusalem cherry. Jimsonweed, Moonflower, both with spiky seed pods, loaded with scopolamine, takes about 50 to "get high;" reverse with physostigmine. Poison hemlock (not same as water hemlock) looks like anise seeds, looks like parsley. A CNS depressant with severe GI irritation. Water hemlock also has GI effects, but is a CNS stimulant that causes seizures in 15-20 minutes. No treatment. ? large doses of cimetidine may help. About 50% fatality.