Common toxic plant ingestion may be intentional (consumption/smoking of concentrated extracts) or accidental.
Severe or life-threatening clinical consequences are rare.
The most lethal plants are the most uncommon and rarely reported exposures: water hemlock, jimson weed seeds, castor bean, rosary pea, monkshood, autumn crocus, and oleander.
There may be physiological effects in the gastrointestinal, cardiac, neurological, respiratory, dermatological, and haematological systems.
Unusual plant ingestions may cause intractable seizures, acidosis, liver necrosis, heart block, hypotension, tachycardia, or hypertension.
Asymptomatic patients are observed for several hours and efforts are made to correctly identify the plant.
The majority are treated with symptomatic and supportive care.
Antidotes are usually only required for digoxin-like plants and cyanide-containing plants.
Plant poisoning occurs after intentional or accidental consumption of toxic plant parts (including fruits, berries, leaves, stems, and roots). Plant parts are most commonly ingested whole, but can also be inhaled by smoking, or consumed in concentrated extracts, chewed seeds, or brewed tea. Although most plant ingestions cause no or mild clinical consequences, several plant chemicals can result in severe symptoms, organ dysfunction, and death.
History and exam
Key diagnostic factors
- presence of risk factors
- altered mental state
Other diagnostic factors
- abdominal pain
- skin flushing
- dermatological/mucosal irritation
- visible bleeding: epistaxis, melaena, haematuria, haematemesis, haemoptysis
- chest pain
- muscle pain/swelling
- skin pallor
- easy bruising
- petechial spotting
- palmar erythema
- spider angiomata
- dry skin
- urinary retention
- neuromuscular weakness
- altered sensation
- foraging for wild plants to eat
- brewing wild plants into tea
- children found or suspected of ingesting plants
1st investigations to order
- serum electrolytes
- serum creatinine
- serum lactate
- serum urea/creatinine
- liver function tests
- chest x-ray
Investigations to consider
- serum digoxin levels
- response to physostigmine
Susan Smolinske, PharmD, DABAT, FAACT
New Mexico Poison and Drug Information Center
Pharmacy Practice and Administrative Sciences
University of New Mexico
SS is a member of the ToxED advisory board and consults with webPOISONCONTROL.
Cynthia K. Aaron, MD
Program Director Medical Toxicology
Regional Poison Center at Children's Hospital of Michigan
Professor of Emergency Medicine and Pediatrics
Wayne State University School of Medicine
CKA owns personal stock in Merck. CKA was on the State of Michigan Public Health Advisory Council for 3 years.
Dr Susan Smolinske and Dr Cynthia K. Aaron would like to gratefully acknowledge Dr Gerald F. O'Malley and Dr Rika N. O'Malley, previous contributors to this topic. GFOM and RNOM declare that they have no competing interests.
GFOM and RNOM declare that they have no competing interests.
Jessamine Soderstrom, MD, MBBS, FACEM
Royal Perth Hospital
JS declares that she has no competing interests.
Scott Phillips, MD
Department of Toxicology
Rocky Mountain Poison & Drug Center
SP declares that he has no competing interests.
Judith Alsop, PharmD, DABAT
Poison Center Director
California Poison Control System, Sacramento Division
University of California Davis Medical Center
Associate Clinical Professor of Pharmacy
University of California San Francisco School of Pharmacy
Clinical Professor of Medicine
Volunteer Clinical Faculty
University of California Davis School of Medicine
JA declares that she has no competing interests.
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