Poisonous plants

Classification of poisoning:
* not potentially fatal
** potentially fatal in large quantities
*** fatal in small quantities

1. ***CASTOR OIL PLANT (RICINIS COMMUNIS)

Progression:
• GIT e6ects within 6 hrs N & V à dehydration, bloody diarrhoea
• Cytotoxicity: 2-5 days à MULTI-ORGAN FAILURE
• Inhaled: Delayed necrosis of broncho-pulmonary tree
• Death - between 3 and 5 days after the initial exposure

Fatal dose: Seeds & mastication

• Child: 3 seeds, Adult: 8 - 20 seeds.
• Pure ricin fatal dose: Ingested: 0.2 mg

Symptoms of acute severe ricin ingestion:

§ Burning pain in the mouth § disorientation
§ nausea § weakness
§ di6iculty swallowing (dysphagia) § stupor
§ vomiting (emesis) § convulsions
§ vomiting blood (hematemesis) § excessive thirst (polydipsia)
§ diarrhoea § blood in the urine (hematuria)
§ bloody stools (melena) § reduced excretion of urine (oliguria)
§ abdominal (epigastric) cramps/pain § multi-system organ failure
§ gastroenteritis § vascular collapse
§ bleeding in the stomach and § shock
intestines § death
§ drowsiness

Ricin MOA:
inhibits protein synthesis nuclease à depurination of 28S rRNA

TXT:
§ Activated charcoal
§ Gastric lavage
§ No antidote – poor prognosis
§ Intensive supportive care
§ Fluids & mannitol, alkalinize urine
2. * CALCIUM OXALATE CONTAINING PLANTS
Causes:
§ Die6enbachia
§ Colocasia
§ Monstera
§ Philodendron
§ Zantedeschia
§ Anthurium
Toxic parts : whole plant, including sap
Poisonous principles: calcium oxalate crystals, toxic proteins, oxalic acid
Symptoms:
§ Burning, oral and oesophageal irritation
§ Breathing, swelling, salivation, loss of speech,
§ eye à inflammation
TXT:
§ emesis
§ local anaesthetic
§ demulcent (milk)
§ analgesics

3. *** PLANTS WITH CARDIAC GLYCOSIDES

A. Foxglove (Digitalis purpurea)
§ All parts toxic, 2-3 leaves à fatal
§ Digitoxin, digitalin, digitonin
B. Oleander (Nerium oleander)
§ All parts toxic, one leaf à fatal
§ Oleandroside, oleandrin, nerioside
NB! Risk : Smoke inhalation
C. Yellow oleander (Thevetia peruviana)
§ All parts toxic, especially seeds
§ Thevetin, thevtoxin, nerifolin
§ Leaves bitter & nauseating
MOA: Bind α-subunit Na+K+-ATPase pump
TXT:
As for digitalis poisoning except Fab fragments only for foxgloves

4. **AMYGDALIN CONTAINING PLANTS

§ Toxic part: seed kernel
§ Amygdalin forms cyanide during digestion
§ Cyanide toxidrome à treat as for cyanide

CAUSE: Prunaceae family

§ Apricot (P . armeniaca) § Firethorn (Pyracantha augustifolia)
§ Apple (P. malus) § Peach (P. persica)
§ Bitter almond (P. amygdalus) § Plum (P. domestica)
§ Sour cherry (P. cerasus) § Wild almond (Brabjum
§ Cherry laurel (P. laurocerasus) stellatifolium)
5.**JERUSALEM CHERRY (SOLANUM PSEUDOCAPSICUM)
§ Toxic parts: unripe berries, leaves
§ Poisonous agent:solanine à CNS depression

SYMPTOMS:
§ N,V,D, abdominal pain
§ headache TXT:
§ shock § Gastric lavage
§ convulsions § Activated charcoal
§ CNS & respiratory depression § Intensive supportive care

6.** SYRINGA TREE (MELIA AZEDARACH)

Toxic parts: berries (also called china berries)
SYMPTOMS:
§ diarrhoea
§ severe abdominal pain
§ poor coordination TXT:
§ convulsions § Emesis /Gastric Lavage/ activated
§ coma charcoal
§ death § carbamazepine

7. *** ANTICHOLINERGICS
Examples:
1. Stinkblaar / Jimsons weed (Datura stramonium)
2. Moonflower (Datura candida)
§ Seeds most toxic
§ Solanaceous alkaloids, atropine, hyoscyamine, scopolamine
3. Deadly nightshade (Atropa belladonna)
§ Atropine

SYMPTOMS: atropine toxidrome

TXT:
§ Emesis, GL, AC
§ Supportive care, diazepam, sodium bicarbonate
§ Neostigmine if no response

8. *** IMPILA (CALLILEPIS LAUREOLA)

Examples: SYMPTOMS
§ Wilde magriet § Confusion, N&V&D, convulsions,
§ Ox-eye daisy § hypoglycaemic coma,
Toxic part: root, traditional remedy § ARF, AHF (hepatic)
Toxic agent: atractylosides TXT
Hepatotoxic à centrilobular necrosis § Emesis, GL, AC
Nephrotoxic à renal tubular necrosis § Intensive supportive care
 POISONOUS MUSHROOMS

Clinical
Name Toxic agents Treatment
presentation
Cyclic octapeptides
Amatoxin à α-amanitin
Inhibit RNA polymerase II
Stage 1 (6-12 hrs)
(prevent transcription)
§ GIT symptoms
No mRNA à no protein
§ N&V&D, pain, haematuria
synthesis § Removal from GIT,
Stage 2 (12-24 hrs)
Nuclear damage à hepatic & § Charcoal hemoperfusion
§ Apparent recovery
renal cells § MDAC
***AMANITA PHALLOIDES, § Increased liver enzymes
Liver: Cell necrosis & § Antidotes: penicillin G à
AMANITA CAPENSIS Stage 3 (24 -72 hrs)
centrilobular haemorrhage decrease binding of
1 mushroom = 1 body (LD = § Coagulopathy
Hepatic failure à hepatic amatoxins
0.1 mg/kg) § Renal failure
encephalopathy § Silibinin (Legalon) decrease
§ Cardiomyopathy
liver uptake of toxin
§ Encephalopathy
Phallotoxin à phalloidin § Silymarin , N-acetylcysteine
§ Convulsions
Damage to cell membranes /
§ coma
binds to actin
§ death
Severe GIT damage (8-12 hrs)
Less potent than amanitin but
faster onset
 § Delirium
9.2 AMANITA MUSCARIA muscimol à hallucinogen à GABA–agonist § Ataxia § Emesis, GL
/AMANITA PANTHERINA ibotenic acid à potent insecticide –agonist
at NMDA
§ inebriation § Physostigmine
convert to muscimol - decarboxylation § hallucinations § atropine
Used as hallucinogen (> 3000 may contain muscarine § convulsions (30 à 120 mins) § IF muscarinic symptoms
yrs) X BBB
§ Exhaustion
§ coma (10-12 hr)
sudden onset 6 hrs post
§ Dizziness
§ Headache
§ Tiredness
§ abdominal pain
§ vomiting § Pyridoxine
9.3 GYROMITRA ESCULENTA Gyromitrin à monomethylhydrazine (MMH)+ formic acid § delirium § methylene blue
(BRAIN FUNGUS) Potentially fatal § convulsions § leucovorin
MMH inhibits glutamic acid decarboxylase
Decrease GABA à CNS excitation, Inhibits DHFR § coma
§ Acute hepatocellular
necrosis
§ Haemolysis
§ methemoglobinemia
 § Causes disulfiram reaction
Coprine à L-
(If alcohol consumed)
9.4 COPRINUS aminocyclopropanol
§ 24 hrs after ingestion § Propranolol
ATRAMENTARIUS (INK CAP) Inhibits acetaldehyde
Flushing, sweating § Fomepizole
dehydrogenase
§ Nausea

9.5 PSILOCYBE & PANAEOLUS § psilocybin § 2 hrs post ingestion

§ Diazepam
SPECIES § psilocin § Hallucination

Onset : =<2 hrs after ingestion

Muscarinic e[ects:
§ Sweating
9.6 CLITOCYBE & INOCYBE § Salivation § Atropine
§ Muscarine
SPECIES § Vomiting § glycopyrolate
§ abdominal colic
§ diarrhoea
§ blurred vision