COMMON POISONOUS PLANTS IN SRI LANKA Dr. R.T.Y.S. RANAWAKA – MEDICAL OFFICER MRS. A.VITHANAGE – RESEARCH OFFICER NATIONAL POISONS AND DRUG INFORMATION CENTRE NATIONAL HOSPITAL - COLOMBO

DIVI KADURU – Eve’s apple (Tabernaemantana dichotoma)

DIVI KADURU Contd… Identification: *Tree - Small, dichotomously branched. *Leaves - Oppositely arranged and oblong in shape. *Fruit - Fleshy, pendulous horizontally divided into two parts, orange, yellowish in colour. *Seeds - Surrounded by a coat of crimson pulp. Seeds are purgative, narcotic and poisonous, producing toxic substance similar to Atropine poisoning.

DIVI KADURU Contd… Symptoms and Signs In mild poisoning - headache, nausea, vomiting, diarrhoea can occur. In severe poisoning - anticholinergic symptoms can occur. dryness of the mucous membranes, thirst , dilation of pupils, flushing of the face, tachycardia, psychomotor disturbances, fits of crying, disturbances of consciouness, delirium, convulsion.

DIVI KADURU Contd… Management–Check A,B,C, Do gastric lavage within 1-2 hrs of ingestion. Give activated charcoal 50-100g in 200ml 1-2 hrs of ingestion. Severe delirium - physostigmine. Convulsions - diazepam. Treat symptomatically where necessary.

GODA KADURU / Bitter nut (Strychnos nux vomica)

GODA KADURU Contd… Identification: *Tree – Smooth yellowish – grey bark and shiny 5 nerved leaves. *Fruit – Round hard glossy orange in colour with jelly like white or pale yellow pulp. *Seeds – Ash grey coloured seeds are concave on one side and convex on the other side. *Toxic substance – Alkaloid strychnine, found in seeds has a selective action on the central nervous system. *Lethal dose – One seed could be lethal.

GODA KADURU Contd… Toxicity is the result of antagonizing the central inhibitory neuro-transmitter glycine by blocking it’s post synaptic uptake at brain stem and spinal cord. This causes hyper-excitation of muscles.

GODA KADURU Contd… Signs and Sym. Following ingestion * In mild cases there is apprehension, muscle twitching, cramps and hyper‑reflexia. In severe poisoning, repeated symmetrical painful convulsions are observed.  They are characterized by extensor spasms, risus sardonicus, and opisthotonus.    * Hyperthermia, metabolic acidosis, rhabdomyolysis, myoglobinuria and renal failure are the other features of poisoning. * The convulsions may last from half to two minutes and is followed by a period of relaxation.  The patient is conscious during the painful convulsions. * Consciousness is lost following repeated convulsions and death results from respiratory failure.

GODA KADURU Contd… Management *Check A, B,C *Convulsions - Diazepam 5-10 IV. Repeat if necessary. To control convulsions phenobarbitone, phenytoin also can use. *After convulsions are controlled consider gastric lavage and give activated charcoal when appropriate. *To correct acidosis –Sodium bicarbanate *If facilities available monitor blood gases SE/BU *Manage the patient in a quiet place with minimal stimuli to prevent Convulsions.

Diya kaduru/Wel Kaduru/Gon Kaduru (Cerbera manghas)

DIYA KADURU Contd… Identification – Growing near the sea, both in the wet / dry zones. Flowers – Pure white with a small yellow heart. Fruits – Rounded green in colour turning in to pink black. Feature of the ripe fruit is look likes a mango. Outer fibrous covering and hence floats.

DIYA KADURU Contd… Toxicity – Cardiotoxic kernel of the fruit contains the cardiac glycosides, cerberine, odollum, thevetin. Toxic part – Kernel of the fruits. Two fruits sufficient to cause death (if not vomited).

DIYA KADURU Contd… Sym. & Signs following ingestion – Burning sensation and dryness of the mouth, nausea, vomiting, diarrhoea and abdominal pain are early features. CVS – Bradycardia,hypotension, 1st and 2nd degree heart block atrial and ventricular extrasystoles, ventricular fibrillation. Convulsions and coma also can occur.

DIYA KADURU Contd… Management *Consider gastric lavage when appropriate. *Give activated charcoal when appropriate. *Do BU/SE, arterial blood gases. *Treat symptomatically where necessary.

KANERU Nerium oleander Thevetia peruviana

KANERU Contd… Identification: Small tree with a milky sap. The leaves are dark green, glossy, linear alternating on the stem. Flowers – Large funnel shaped yellow, pink, red and white flowers grouped at the end of the branches. Fruit – Green when immature, yellow to black when ripe, triangular in out line with a raised ridge around the middle. Toxic substance – Cardiac glycosides, Thevetin A and Thevetin B. Toxic part – All parts of plant especially the fruits. Fatality – Ingestion of the kernel of one fruit may prove to be fatal to child

*Ingestion of the fruit causes nausea and vomiting early, KANERU Contd… *Ingestion of the fruit causes nausea and vomiting early, due to the local irritant effect of the stomach.   Vomiting 6 to 12 hours after ingestion implies significant absorption of the toxin. *Cardio‑toxicity causes bradycardia, varying degrees of heart block and hypotension.  There may be atrial and ventricular ectopics and other ventricular arrhythmias. *Other toxic effects are yellow vision (xanthopsia), anxiety, convulsions and coma.

KANERU Contd… Management * An asymptomatic patient should be observed in a hospital for 24 hours. * Consider gastric lavage when appropriate. * Give activated charcoal when appropriate and repeat it the rate of 12.5- 25g every 4 hrs until recovery. * Monitor pulse,BP and respiration and maintain a fluid balance chart. * Check SE four hourly * If facilities are available do cardiac monitoring, otherwise do ECGs. * Treat symtomatically where necessary. * Convulsion – Diazepam 5 -10 mg IV. * Bradycardia – Atropine 0.5 to 2mg IV.

OLINDA / Crab’s eye (Abrus precatorius)

OLINDA Contd… Identification – Slender creeper with alternatively placed compound leaves, flowers purple crowded at the end of a stalk. Seeds – Highly attractive seeds, hard shiny and scarlet in colour with black eye at the hilus. Toxic substance – Toxalbumin called Abrin Toxic part – Seeds are extremely poisonous. Even a single cracked seed can be fatal.

OLINDA Contd… Nausea, vomiting, diarrhoea and abdominal cramps are observed due to the irritant effect on the gastro-intestinal mucosa by abrin. Erosions of the mucosa result in haematemesis and melaena.   Hepatotoxicity is manifested by elevated levels of transaminases and serum bilirubin. Haemaglutination and haemolysis of red cells, hypovolaemic shock and direct toxic effect on kidneys lead to acute renal failure. Retinal haemorrhages, pallor due to anaemia, hypoglycaemia, drowsiness and convulsions are some of the other features observed.

OLINDA Contd… Nausea, vomiting, diarrhoea and abdominal cramps are observed due to the irritant effect on the gastro-intestinal mucosa by abrin. Erosions of the mucosa result in haematemesis and melaena.   Hepatotoxicity is manifested by elevated levels of transaminases and serum bilirubin. Haemaglutination and haemolysis of red cells, hypovolaemic shock and direct toxic effect on kidneys lead to acute renal failure. Retinal haemorrhages, pallor due to anaemia, hypoglycaemia, drowsiness and convulsions are some of the other features observed.

OLINDA Contd… MANAGEMENT If seeds were swalled without chewing, toxicity is unlikely and decontamination is not needed. If uncertain, give activated charcoal. Monitor pulse, respiration and BP and maintain a fluid balance chart. Check SE Treat symptomatically where appropriate.

HONDALA (Adenia Palmata)

HONDALA Contd… Identification – Perennial herb growing in wet zone. Fruits – Closely resembles to passion fruit, responsible for accidental poisoning among children. Unripe fruit – Green colour, ripe fruit – yellow organge or scarlet in colour. It is divided in to 3 equal parts. Seeds are covered with soft, jelly like material. It contains cyanogenic glycoside and toxalbumin. Most toxic part is the Fruit

HONDALA Contd… Clinical manifestations occur in three phases.   First phase: Abdominal pain, diarrhoea, vomiting, fever, restlessness and dizziness are the main features. Second phase: Diarrhoea with blood and mucus, and pain and tenderness over the right iliac fossa may be observed. These manifestations are due to necrotising enteritis.                                                                                     Third phase: This phase is believed to be due to hypersensitivity reactions and occur 2 to 3 weeks after ingestion.  There is myocarditis with ECG changes, tender enlarged liver, retinopathy with papilloedema, exudate and haemorrhages.

MANAGEMENT Do gastric lavage when appropriate. Give activated charcoal when appropriate Treat symtomatically where appropriate.

CASTOR OIL PLANT Beheth Endaru / Thel Endaru (Ricinus communis)

CASTOR OIL PLANT Contd… Identification: * Leaves - Very broad, roundish in outline and partly divided into 7 lobes, margins being toothed. * Fruits - Has a prickly capsule and is lobulated. * Seeds - Oval in shape have a brittle covering and are brown in colour with irregular grey spots. * Toxic substance – Toxalbumin ‘ricin’. Ricin found throughout the plant with maximum concentration in the seeds. * Ingestion of a single thoroughly chewed bean has caused fatal poisoning.

WETA ENDARU (Jatropha curcas) Identification – Small tree/shrub with undulating five lobed leaves and yellowish green flowers. Toxic substance – Toxalbumin curcin (one of the most toxic substances among plants) found throughout the plant with maximum concentration in the seeds.

ENDARU Contd… Poisoning is observed only after a latent period of several hours. Signs and Sym. are nausea, vomiting, epigastric and abdominal pain and diarrhoea resulting in dehydration, electrolyte imbalance, cramps and shock.  Other features of poisoning are hypoglycaemia, retinal haemorrhages, haematuria, convulsions, and shock.  Hepatic necrosis and acute renal failure have been reported.  

ENDARU Contd… MANAGEMENT Do gastric lavage when appropriate. Give activated charcoal when appropriate. Check BU/SE, liver funtion test,Hb, Serum creatinine. Treat symtomatically where appropriate.

NIYANGALA / Glory Lily (Gloriosa superba)

NIYANGALA Contd… Common suicidal poison in rural areas. Identification – A notable feature is the colourful flower. Toxic parts – All parts of the plant. Toxic substance – Alkaloid Colchicine Lethal dose – Adult: 6 mg to 20 mg (10 g of the fresh tubers contains about 6 mg of colchicine) Children: 0.5 and 0.8 mg/kg

NIYANGALA Contd… Toxic effects develop within 6 to 12 hours of ingestion. Sigs &Sym. - severe gastroenteritis with abnomial pain, Nausea,Vomiting, Diarrhoea with blood …dehydration… Hypovolaemia, hypotension, shock. 1st24 hrs later granulocytopenia, thrombocytopenia, clotting defects with bleeding manifestation. Cardic arrythmias, hepatic failure ,renal faure, res. failure, DIC, convulsions and coma.

NIYANGALA Contd… MANAGEMENT Do gastric lavage when appropriate. Give activated charcoal when appropriate. Multiple dose activated charcoal may be helpful. Treat symptomatically where appropriate.

ATTANA / Thorn Apple (Datura stramonium)

ATTANA / Thorn Apple Contd… Tree – Small plant with dark green and pointed leaves. Flowers are gramophone shaped and white or purple in colour. Fruit is spherical thorny and attractive resemblin to ‘rambutan’. Seeds – Resemble gingelly seeds, yellowish brown in colour. Toxic substance – Alkaloids atropine, hyoscine and hyoscyamine. Toxic parts – Whole plant is poisonous, but seeds are the most poisonous. Lethal dose – Even a single seed is toxic.

ATTANA / Thorn Apple Contd… Signs and Sym. Similar to anticholinergic toxicity * Thirst ,dryness of the mouth * CVS effects- sinus tachycadia,hypertension supraventricular and ventricular dysrthythmias * Dialated pupils and blurred vision * Skin is hot dry and flushed * Severe poisoning causes disorientation, agitation, violent behaviour, visual and auditary hallucinations convulsions, respiratory failure and coma.

ATTANA / Thorn Apple Contd… MANAGEMENT Do gastric lavage when appropriate. Give activated charcoal when appropriate. Fits – Diazepam 5- 10 mg IV Check BU/SE, Blood gas Treat symtomatically where appropriate.

HABARALA DUMB-CANE

HABARALA (Alocasia macrorrhiza) Identification Large herb with tunerous root. Leaves are large and simple, no characteristic pattern. Toxic substance – Calcium oxalate crystals and unidentified volatile compounds. Some other household decorative plants e.g Dumb-cane and Caladium sp., also contains above toxic substances.

HABARALA Contd… Signs & Sym. Initially profuse salivation, irritation, burning sensation and pain of the oral cavity following ingestion stalks of the plant. Later oedema of the tongue, lips, cheeks, salivary glands and throat lead to disphagia and aphonia. Ingestion of large amount lead to necrotic oesophagitis and haemorrhagic gastritis. Death may result from laryngeal oedema. Bradycardia, tremos, muscle twitching and trismus, convulsions and acute renal failure also can occur.

HABARALA Contd… Management For severe pain – analgesics (parenteral analgesics may necessary). To reduce the mouth irritation suck ice and milk. Respiratory obstruction – Intubation of tracheostomy. Check renal function and SE/BU and Serum calcium. Maintain a fluid balance chart. Treat symptomatically where necessary.

KEPUNKIRIYA (Euphorbia hirta)

KEPUNKIRIYA Contd… Identification Herb with an erect stout stem, covered with bristly hair. Fruit is a capsule, hairy, 3 lobed, each splitting ventrally and dorsally. Seeds-avoid, wrinkled and reddish brown in colour. Toxic substances – Alkaloid xanthoramine, gallic acid, phenolic substance etc. Vegetative and reproductive organs – hydrocyanic acid.

KEPUNKIRIYA Contd… Signs and Symptoms Common symptoms are: Nausea, vomiting, and drowsiness. Observe for cyanide poisoning features

KEPUNKIRIYA Contd… Management Check A, B, C. Give activated charcoal 50-100g in 200ml 1-2 hrs of ingestion. Treat symptomatically where necessary

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