Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9e

Chapter 221: Poisonous Plants

Betty Chen; Lewis S. Nelson

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 221-1 and 221-2).^1,2 Individual plants are discussed in terms of their pathophysiology, clinical features (toxidromes), and treatment.³ Highly poisonous plants (Table 221-1) are highlighted in depth below, and brief reviews are provided for other common poisonous plants. Table 221-2 organizes common poisonous plants according to toxin structure.

TABLE 221-1Examples of Severely Poisonous Plants

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TABLE 221-1 Examples of Severely 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 221-2Classification of Poisonous Plants

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TABLE 221-2 Classification of Poisonous Plants

Toxin Structure

Examples

Alkaloids

Solanine and chaconine

Green potato leaves, American nightshade, black nightshade (Solanaceae)

Anticholinergics

Deadly nightshade (Atropa belladonna)

Angel’s trumpet or jimson weed (Datura spp. and Solandra spp.)

Henbane (Hycoscyamus niger)

Mandrake (Mandragora officinarum)

Cholinergics

Calabar bean (Physostigma venenosum)

Pilocarpus (Pilocarpus spp., often grouped and called jaborandi)

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 (Argyreia spp. and Ipomoea spp.)

Hawaiian baby woodrose seeds (Argyreia nervosa)

Ayahuasca (Banisteriopsis caapi)

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)

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 (...

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