James H. Diaz, MD, MPH&TM, DrPH Wilderness & Environmental Medicine

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Presentation transcript:

Poisoning by Herbs and Plants: Rapid Toxidromic Classification and Diagnosis James H. Diaz, MD, MPH&TM, DrPH Wilderness & Environmental Medicine Volume 27, Issue 1, Pages 136-152 (March 2016) DOI: 10.1016/j.wem.2015.11.006 Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 1 Nerium oleander, a Mediterranean native, contains the cardiac glycoside, oleandrin, in all of its parts. Source: Wikipedia (public domain). Wilderness & Environmental Medicine 2016 27, 136-152DOI: (10.1016/j.wem.2015.11.006) Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 2 Zigadanus freemontii, death camas, all parts of which are toxic, contains several sodium channel activators that are refractory to reversal with digoxin-specific Fab. Source: Wikipedia (public domain). Wilderness & Environmental Medicine 2016 27, 136-152DOI: (10.1016/j.wem.2015.11.006) Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 3 Brugmasia suaveolens, the angel’s chalice or trumpet plant, is a widely cultivated, flowering vine throughout the temperate world, all parts of which contain anticholinergic terpene alkaloids (atropine, hyoscyamine, and scopolamine). Teas brewed from plant leaves or flowers will cause a central and peripheral anticholinergic syndrome with delirium and hallucinations. Source: Source: Wikipedia (public domain). Wilderness & Environmental Medicine 2016 27, 136-152DOI: (10.1016/j.wem.2015.11.006) Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 4 The hollow stem of Cicuta maculata, water hemlock, has been used to make toy whistles, which have caused fatal cicutoxin poisonings after oral mucosal contact. Source: Personal collection. Wilderness & Environmental Medicine 2016 27, 136-152DOI: (10.1016/j.wem.2015.11.006) Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 5 Colorful Ricinus communis or castor bean seeds often used in tropical native jewelry will release the toxalbumin, ricin, a powerful protein synthesis inhibitor, when chewed, with severe gastrointestinal toxicity and potential multisystem organ failure. However, the ingestion of intact seeds does not cause toxicity and will not require therapy. Source: United States Department of Agriculture (USDA). Wilderness & Environmental Medicine 2016 27, 136-152DOI: (10.1016/j.wem.2015.11.006) Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 6 Colorful Abrus precatorius or jequirity or rosary pea seeds often used in tropical native jewelry will release the toxalbumin, abrin, when chewed, with severe gastrointestinal toxicity and potential multisystem organ failure. However, the ingestion of intact seeds does not cause toxicity and will not require therapy. Source: United States Department of Agriculture (USDA). Wilderness & Environmental Medicine 2016 27, 136-152DOI: (10.1016/j.wem.2015.11.006) Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 7 Ripe elderberries on the American elder tree, Sambucus mexicana. Although the ripe berries are edible and often used in juices and jams, the leaves, stems, bark, and roots of elderberry trees contain cyanogenic glycosides capable of causing symptomatic cyanide poisoning. Source: Wikipedia (public domain). Wilderness & Environmental Medicine 2016 27, 136-152DOI: (10.1016/j.wem.2015.11.006) Copyright © 2016 Wilderness Medical Society Terms and Conditions