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Plant poisoning
Dr. Kalirattiname
Toxic Plants
One of the most frequent poisonings reported to
poison control centers
69% of plant exposures reported to poi...
Toxic Plants, cont.
Almost any plant can cause nausea, vomiting and
intestinal cramping
Not all parts of a plant are alway...
General management of a Plant
poisoned patient
Treat all cases of plant ingestion as potentially
toxic until shown otherwi...
General management of a Plant
poisoned patient
Demulcent therapy - ice cream, milk, egg
whites
Observe patient for clinica...
Common Poisonous Plants
Arum family
Most common toxic plant exposure reported in the
US. And a very common plant in homes and
public places
Member...
Signs, Symptoms and Treatment
Non soluble needle like Ca++ oxylate crystals are
found in all parts of the plant, stalk pro...
Caladium
Dumbcane
Split leafed
Philodendron
Christmas plants
American Holly
Mistletoe
Poinsettia
American Holly
Berries are toxic, contain Ilicin
Clinical signs
Nausea, severe vomiting, abdominal pain,
diarrhea
Treatmen...
Jerusalem
Cherry
Mistletoe
Berries are toxic , contain B-phenylethylamine
and tyramine
Clinical signs
acute gastroenteritis, cardiovascular...
Poinsettia
Non toxic
contains a latex sap which can be
slightly irritating to mucous
membranes
Treatment - give demulcents
Poinsettia
Cardiotoxic Plants
Contain cardiac glycosides
Oleander
Azaleas
Lilly of the valley
Cardiotoxic plants
First used by Egyptians as emetics and for
heart aliments
Toxicity occurs usually after consuming
teas ...
Cardiotoxic plants
Clinical signs:
tachycardia
V fib
Toxic exposure is rare
AAPCC reports in 1998 - 2,553 exposures (out o...
Oleander
Very toxic plant, common ornamental
Clinical signs
GIT irritation, vomiting, abdominal pain,
diarrhea, hyperkalem...
Oleander
Oleander
Azaleas
Rhododendron, Bird of paradise
contain andromedotoxin
Treatment - Ipecac, activated charcoal,
transport
Azaleas
Castor Bean
Castor bean
Contain phytotoxins - ricin - inactivated by heat
during the production of castor oil
seeds are the most toxic...
Castor
Bean
Rhubarb
Rhubarb
Leaves are toxic, contain oxalic acid, heating
does not destroy the toxic principle
Stems are edible
Clinical sign...
Rhubarb
Jimsonweed
Datura stramonium
Jimsonweed Toxicity
Plant alkaloids are metabolites that have a nitrogen
containing chemical ring
This plant has a history...
Jimsonweed Toxicity
toxic agents - solanaceous alkaloids, atropine,
hyoscyamine and scopolamine
highest concentration of a...
Jimsonweed toxicity, cont.
Clinical features:
tachycardia, dry flushed skin, dry mucous
membranes, mydriasis, blurred visi...
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
mai...
Jimsonweed,
thorn apple,
angel’s trumpet
Jimsonweed, seed pod
Pokeweed
Pokeweed
AKA Inkberry, pigeonberry
Roots and leaves are the most toxic, fruit is
mildly toxic
Toxic principle is a resinou...
Poke weed
Clinical signs
produces a burning sensation in the mouth, GI
cramps, vomiting, diarrhea, visual disturbances,
di...
Pokeweed, Ink berries
Toxicodendron
Poison Ivy
All portions of the plant, even the smoke from
burning leaves
Toxic principle - an oily oleoresin called
urushi...
Poison Ivy
50-70% of US population is susceptible
Poison ivy east of the Rockies, poison oak
west and poison sumac in the ...
Poison Ivy, cont.
Treatment:
avoid contact, wash affected area with soap and
rinse with alcohol, repeat
2 tbsp. Epsom’s sa...
Poison Ivy, cont.
Treatment: cont.
calamine lotion
zinc oxide ointment
baking soda paste (one tablespoon of baking
soda to...
Poison Ivy, cont.
Treatment: cont.
If you were exposed to the smoke of burning
poison ivy, oak or sumac and you believe yo...
Poison Ivy
Mushroom Toxicity
Mushroom toxicity
1999 AAPCC reported 8996 mushroom
exposures, 2930 treated in a hospital and 6
fatalities
5976 of these i...
Mushroom toxicity
Never eat any wild mushroom
Etiology - consumption of raw or cooked
mushrooms/toadstools
Cooking, cannin...
Categories of Mushroom Toxicity
I) Protoplasmic poisons - destruction of cells
Signs and Symptoms
Stage I - first 6-24 hrs...
Examples of Mushrooms which
cause protoplasmic poisoning
Amanita phalloides
Contain a mixture of heat stable
cyclopeptides including:
phalloidin
phalloin
amatoxin - accounts for t...
Amanita phalloides
Categories of Mushroom Toxicity, cont.
II) Neurotoxins
contain compounds which cause neurological
signs and symptoms, conv...
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,
diarrhe...
Green gill
These large, common mushrooms often
appear in fairy rings on suburban lawns,
commonly called toadstools.
They c...
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...
Green gill, green spored
Categories of Mushroom Toxicity, cont.
IV) Disulfiram-like compounds
generally non toxic and produce no clinical
signs unl...
Inky cap mushroom
Diagnosis of Human toxicity
Clinical testing
History
Outbreaks are not very common
Usually isolated cases - seen in people...
Plant poisoning
Plant poisoning
Plant poisoning
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Plant poisoning

  1. 1. Plant poisoning Dr. Kalirattiname
  2. 2. 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 plants Account for 5-10% of calls to poison control center Incidence is increasing Toxicity's can also occur when plants have been treated with herbicides, insecticides or fertilizers
  3. 3. 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
  4. 4. General management of a Plant poisoned patient Treat all cases of plant ingestion as potentially toxic until shown otherwise First try and ID the plant, try to get actual plant if possible Time is on the side of the patient, determine when exposure happened. Determine how much was ingested. Call poison control center
  5. 5. General management of a Plant poisoned patient Demulcent therapy - ice cream, milk, egg whites Observe patient for clinical signs If indicated induce vomiting - syrup of Ipecac Activated charcoal should be given Cathartics hasten removal of remaining material
  6. 6. Common Poisonous Plants
  7. 7. Arum family Most 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 crystals Used for variety of purposes: punishing slaves, treating gout, impotence and frigidity
  8. 8. Signs, Symptoms and Treatment Non 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)
  9. 9. Caladium
  10. 10. Dumbcane
  11. 11. Split leafed Philodendron
  12. 12. Christmas plants American Holly Mistletoe Poinsettia
  13. 13. American Holly Berries are toxic, contain Ilicin Clinical signs Nausea, severe vomiting, abdominal pain, diarrhea Treatment - Ipecac, activated charcoal
  14. 14. Jerusalem Cherry
  15. 15. 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
  16. 16. Poinsettia Non toxic contains a latex sap which can be slightly irritating to mucous membranes Treatment - give demulcents
  17. 17. Poinsettia
  18. 18. Cardiotoxic Plants Contain cardiac glycosides Oleander Azaleas Lilly of the valley
  19. 19. 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.
  20. 20. 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)
  21. 21. Oleander Very toxic plant, common ornamental Clinical signs GIT irritation, vomiting, abdominal pain, diarrhea, hyperkalemia, AV block, cardiogenic shock Treatment - Ipecac, activated charcoal, transport
  22. 22. Oleander
  23. 23. Oleander
  24. 24. Azaleas Rhododendron, Bird of paradise contain andromedotoxin Treatment - Ipecac, activated charcoal, transport
  25. 25. Azaleas
  26. 26. Castor Bean
  27. 27. Castor bean Contain phytotoxins - ricin - inactivated by heat during the production of castor oil seeds are the most toxic part of the plant, 2-4 seeds could be fatal in adult Clinical signs nausea, violent vomiting and diarrhea, burning sensation in the mouth, hemolysis, renal failure, death Treatment - Ipecac, activated charcoal, transport
  28. 28. Castor Bean
  29. 29. Rhubarb
  30. 30. Rhubarb Leaves are toxic, contain oxalic acid, heating does not destroy the toxic principle Stems are edible Clinical signs abdominal pain, vomiting, diarrhea, headache, muscle cramps, tetany, renal failure Treatment - Ipecac, activated charcoal, transport
  31. 31. Rhubarb
  32. 32. Jimsonweed Datura stramonium
  33. 33. Jimsonweed Toxicity Plant alkaloids are metabolites that have a nitrogen containing chemical ring This 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 deaths Toxicity manifests as classic anticholinergic posioning
  34. 34. 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 tea Reports of smoking the leaves of the plant
  35. 35. 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
  36. 36. 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
  37. 37. Jimsonweed, thorn apple, angel’s trumpet
  38. 38. Jimsonweed, seed pod
  39. 39. Pokeweed
  40. 40. Pokeweed AKA Inkberry, pigeonberry Roots and leaves are the most toxic, fruit is mildly toxic Toxic principle is a resinous material and a water soluble saponin
  41. 41. 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
  42. 42. Pokeweed, Ink berries
  43. 43. Toxicodendron
  44. 44. 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
  45. 45. Poison Ivy 50-70% of US population is susceptible Poison 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
  46. 46. 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
  47. 47. 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
  48. 48. 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.
  49. 49. Poison Ivy
  50. 50. Mushroom Toxicity
  51. 51. Mushroom toxicity 1999 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
  52. 52. Mushroom toxicity Never eat any wild mushroom Etiology - consumption of raw or cooked mushrooms/toadstools Cooking, canning or freezing WILL NOT render toxic mushrooms non toxic Clinical Syndromes - usually acute onset of signs and symptoms
  53. 53. Categories of Mushroom Toxicity I) Protoplasmic poisons - destruction of cells Signs 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
  54. 54. Examples of Mushrooms which cause protoplasmic poisoning
  55. 55. Amanita phalloides Contain a mixture of heat stable cyclopeptides including: phalloidin phalloin amatoxin - accounts for the lethality
  56. 56. Amanita phalloides
  57. 57. Categories of Mushroom Toxicity, cont. II) Neurotoxins contain compounds which cause neurological signs and symptoms, convulsions, hallucinations, excitation, depression, spastic colon.
  58. 58. Examples of Mushrooms which cause Neurologic signs and symptoms
  59. 59. Amanita muscarina
  60. 60. Inocybe sp.
  61. 61. Inocybe sp.
  62. 62. Inocybe sp.
  63. 63. Inocybe sp.
  64. 64. Psilocybe sp.
  65. 65. Psilocybe sp.
  66. 66. Categories of Mushroom Toxicity, cont. III) Gastrointestinal irritants cause nausea, vomiting, abdominal cramping, diarrhea Examples: green gill, gray pink gill, etc.
  67. 67. Green gill These 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.
  68. 68. 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.
  69. 69. Green gill, green spored
  70. 70. 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
  71. 71. Inky cap mushroom
  72. 72. Diagnosis of Human toxicity Clinical testing History Outbreaks are not very common Usually isolated cases - seen in people who go out picking mushrooms Patient management - induce vomiting, give activated charcoal, seek medical help
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Plant poisoning

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