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Chapter 220: Poisonous Plants

Betty C. Chen; Lewis S. Nelson

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    AMA Citation
    Chen BC, Nelson LS. Chen B.C., Nelson L.S. Chen, Betty C., and Lewis S. Nelson.Poisonous Plants. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. Tintinalli J.E., Stapczynski J, Ma O, Yealy D.M., Meckler G.D., Cline D.M. Eds. Judith E. Tintinalli, et al.eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016. http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=1658&sectionid=109386389. Accessed February 18, 2020.
    MLA Citation
    Chen BC, Nelson LS. Chen B.C., Nelson L.S. Chen, Betty C., and Lewis S. Nelson.. "Poisonous Plants." Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. Tintinalli J.E., Stapczynski J, Ma O, Yealy D.M., Meckler G.D., Cline D.M. Eds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016, http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=1658&sectionid=109386389.

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INTRODUCTION

Common poisonous and injurious plants number in the hundreds and have a wide variety of toxicities. This chapter focuses on the most important plant-related exposures clinically relevant to emergency medicine (Tables 220-1 and 220-2).1,2 Individual plants are discussed in terms of their pathophysiology, clinical features (toxidromes), and treatment.3 Highly poisonous plants (Table 220-1) are highlighted in depth below, and brief reviews are provided for other common poisonous plants. Table 220-2 organizes common poisonous plants according to toxin structure.

TABLE 220-1Some Highly Poisonous Plants
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TABLE 220-1 Some Highly Poisonous Plants

Poison hemlock (Conium maculatum)

Yew (Taxus spp.)

Foxglove (Digitalis purpurea)

Oleander (Nerium oleander)

Castor bean (Ricinus communis)

Rosary pea (Abrus precatorius)

Water hemlock (Cicuta maculata)

Buckthorn (Karwinskia humboldtiana)
TABLE 220-2Classification of Poisonous Plants
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TABLE 220-2 Classification of Poisonous Plants
Classification Mechanism of Toxicity Example Plant Species
Alkaloids Solanine and chaconine Green potato leaves, American nightshade, black nightshade (Solanaceae)
Anticholinergics

Deadly nightshade (Atropa belladonna)

Angel's trumpet or jimsonweed (Datura spp.)

Henbane (Hycoscyamus niger)

Mandrake (Mandragora officinarum)
Cholinergics

Calabar bean (Physostigma venenosum)

Pilocarpus (Pilocarpus spp.)
Nicotinic and nicotine-like

Tobacco (Nicotiana spp.)

Poison hemlock (Conium maculatum)

Golden chain (Laburnum anagyroides)

Blue cohosh (Caulophyllum thalictroides)

Lupin (Lupinus spp.)
Psychotropics

Peyote (Lophophora williamsii)

Nutmeg and mace (Myristica fragrans)

Morning glory (Agyreia spp. and Ipomoea spp.)

Hawaiian baby woodrose seeds (Argyreia nervosa)
Hepatotoxic pyrrolizidines

Comfrey (Symphytum officinale)

Sassafras (Sassafras albidum)

Ragwort (Heliotropium spp.)
Sodium channel modulators

Monkshood (Aconitum spp.)

Larkspur (Delphinium spp.)

False or green hellebore (Veratrum spp.)

Yew (Taxus spp.)
Antimitotic alkaloids and resins

Autumn crocus (Colchicum autumnale)

Mayapple (Podophyllum peltatum)

Wild mandrake (Podophyllum emodi)

Glory lily (Gloriosa superba)

Madagascar periwinkle (Catharanthus roseus)
Glycosides Cardioactive steroids or cardiac glycosides

Foxglove (Digitalis purpurea)

Lily of the valley (Convallaria majalis)

Oleander (Nerium oleander)

Christmas rose (Helleborus niger)

Milkweed (Asclepias spp.)

Squill (Urginea maritime and Urginea indica)

Yellow oleander (Thevetia peruviana)
Cyanogenic glycosides

Almond, apricot, and cherry pits (Prunus spp.)

Tapioca plant, cassava (Manihot esculenta)

Elderberry (Sambucus canadensis)

Hydrangea (Hydrangea macrophylla)
Saponins Holly (Ilex spp.)
Salicylates

Poplar species (Populus spp.)

Willow species (Salix spp.)
Proteins, peptides, and lectins Toxalbumins

Castor bean (Ricinus communis)

Rosary pea (Abrus precatorius)

Pokeweed (Phytolacca americana)

Black locust (Robinia pseudoacacia)

American mistletoe (Phoradendron flavescens)

European mistletoe ...

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