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Clinical Summary

Many common houseplants such as dieffenbachia (dumb cane) and peace lily cause irritant effects when ingested owing to large amounts of insoluble oxalate crystals in its leaves. The oxalate crystals are highly irritating, and those who ingest the leaves experience painful burning of the lips, tongue, mouth, and esophagus. Marked swelling of the tongue, lips, and oropharynx can occur, and airway patency may become a major issue in managing these patients. Ocular exposures may occur as well, resulting in painful burning, erythema, and eyelid swelling. Fortunately, these calcium oxalate crystals are not absorbed, and hypocalcemia is not an issue.

Management and Disposition

Topical anesthetics are helpful in controlling severe pain from burning mucous membranes. Management is largely supportive, as the painful oral burns experienced with these exposures usually limit ingestion. As with any oropharyngeal burn, airway issues must be addressed. A period of observation is appropriate to make sure that airway compromise does not occur with continued swelling. If leaves are swallowed and the patients are symptomatic, GI consultation should be considered to assess the extent of esophageal injury. Gastrointestinal decontamination is usually not necessary.

FIGURE 17.100

Dieffenbachia. Dieffenbachia is a common houseplant because of its colorful appearance and ease of indoor growth. (Photo contributor: Kevin J. Knoop, MD, MS.)

Pearls

  1. Performance of nasopharyngoscopy may be helpful in assessment of airway patency for more posterior burns.

  2. Patient should be instructed not to swallow topical anesthetics, as toxicity may result with extensive use.

FIGURE 17.101

Peace Lily. The attractive foliage and blooms make this a popular house plant; however, it is not a true lily. (Photo contributor: Saralyn R. Williams, MD.)

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