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Pokeweed (Phytolacca americana) is one of the most common ingested plants and contains a toxin called phytolaccotoxin. Pokeweed leaves are sometimes occasionally eaten as a vegetable (poke salad) after parboiling the leaves. If the leaves or unripe berries are eaten raw, acute onset of gastroenteritis occurs within a few hours of ingestion. Bradycardia, heart blocks, and hypotension have been reported as well.
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Accidental ingestion of the ripe berries is a common exposure in young children who may mistake the berries for blueberries. Typical purple staining of the hands and the mouth commonly occurs.
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Management and Disposition
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Care is primarily supportive for symptomatic patients. Intravenous fluids should be administered, and antiemetics may be given. Patients who have no symptoms within a few hours of ingestion may be discharged to home. Children who ingest the berries usually demonstrate a limited amount of toxicity and may be discharged with reassurance.
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Phytolaccotoxin may cause a lymphocytosis a few days after ingestion. There is little clinical significance to this laboratory effect.
Purple staining of the hands, perioral area, or clothing may be a physical examination clue that pokeweed ingestion has occurred when history is lacking.
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