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.
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.
Management and Disposition
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.
Pokeweed Plant. This is the typical appearance of a tall pokeweed plant with immature white berries and mature purple berries. (Photo contributor: Saralyn R. Williams, MD.)
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.
Pokeweed Berries. This is a close-up of the mature purple pokeweed berries; these may be easily mistaken for blueberries given their similar appearance. (Photo contributor: Saralyn R. Williams, MD.)