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 physiologic effects in the gastrointestinal, cardiac, neurologic, pulmonary, dermatologic, and hematologic 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. Most plant ingestions cause no or mild clinical consequences; however, several plant chemicals can result in severe symptoms, organ dysfunction, and death.
History and exam
Key diagnostic factors
- altered mental state
Other diagnostic factors
- abdominal pain
- skin flushing
- dermatologic/mucosal irritation
- visible bleeding: epistaxis, melena, hematuria, hematemesis, hemoptysis
- 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 BUN/creatinine ratio
- liver function tests
- chest x-ray
Investigations to consider
- serum digoxin levels
- response to physostigmine
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