Plant Poisoning: Poisoning: Merck Manual Professional

In This Topic

Injuries; Poisoning
	Poisoning
		Plant Poisoning
			Castor beans and jequirity beans
			Oleander and foxglove
			Hemlock

Resources

Plant Poisoning

Share This

A few commonly grown plants are highly poisonous, and many plants are moderately poisonous (see Table 6: Poisoning: Moderately Poisonous Plants). Few plant poisonings have specific antidotes. Most plant ingestions, including the plants listed in Table Table 6: Poisoning: Moderately Poisonous Plants, result in minimal symptoms unless the leaves and other components are concentrated into a paste or brewed into a tea.

Highly toxic and potentially fatal plants include the following:

Castor beans and jequirity beans
Oleander and foxglove
Hemlock

Castor beans and jequirity beans: Castor beans contain ricin, an extremely concentrated cellular poison. Jequirity beans contain abrin, a related and even more potent toxin. In both, the beans have a relatively impervious shell; thus, the bean must be chewed to release the toxin. However, the seed coating of the jequirity bean is often not intact, and simple bacterial digestion can release the abrin toxin.

Symptoms of either poisoning may include delayed gastroenteritis, sometimes severe and hemorrhagic, followed by delirium, seizures, coma, and death. Whole-bowel irrigation should be considered because it aims to remove all beans ingested.

Oleander and foxglove: These plants and lily of the valley (which is similar but less toxic) contain digitalis glycosides. Toxicity includes gastroenteritis, confusion, hyperkalemia, and arrhythmias. The serum digoxinSome Trade Names
DIGITEK
LANOXIN
Click for Drug Monograph
level can confirm ingestion but is not useful as quantitative information.

K levels are closely monitored. Hyperkalemia may respond only to hemodialysis. Ca is not recommended for arrhythmias. DigoxinSome Trade Names
DIGITEK
LANOXIN
Click for Drug Monograph
-specific fractionated antibody (Fab) fragments have been used to treat ventricular arrhythmias.

Hemlock: Hemlock poisoning (poison hemlock and water hemlock) can cause symptoms within 15 min.

Poison hemlock has nicotinic effects, beginning with dry mouth and progressing to tachycardia, tremors, diaphoresis, mydriasis, seizures, and muscle paresis. Rhabdomyolysis and bradycardia may occur.

Water hemlock seems to enhance γ-aminobutyric acid (GABA) activity. Symptoms may include gastroenteritis, delirium, refractory seizures, and coma.

Table 6

Print Open table in new window

Moderately Poisonous Plants
Plant	Symptoms	Treatment
Aconitine (eg, derived from monkshood)	Bradycardia, dysrhythmias, paresthesia, weakness	Supportive care Sodium bicarbonate
Aloe spp	Gastroenteritis, nephritis, skin irritation	Supportive care and irrigation with soap and water
Aristolochia spp (birthworts, pipevines)	Tubulointerstitial nephropathy	Supportive care
Azalea	Cholinergic symptoms	Supportive care and atropineSome Trade Names ATROPEN ATROPINE-CARE SAL-TROPINE Click for Drug Monograph
Caladium spp (elephant ear, angel's wings)	Oral mucosal damage due to Ca oxalate crystals in leaves	Supportive care and demulsification (eg, with milk or ice cream)
Capsicum spp (peppers)	Mucous membrane irritation and swelling	Supportive care, irrigation
ColchicineSome Trade Names No US trade name Click for Drug Monograph (autumn crocus, meadow saffron, glory lily)	Delayed gastroenteritis, multiple organ failure Bone marrow suppression	Supportive care and possibly, as a last resort, experimental colchicineSome Trade Names No US trade name Click for Drug Monograph -specific Fab fragments*
Cyanogenic glycosides (eg, in Prunus spp [eg, peach, apricot, and wild cherry pits], Malus spp [eg, apple seeds],and other seeds)	Symptoms of cyanide poisoning	HydroxocobalaminSome Trade Names CYANOKIT Click for Drug Monograph Cyanide antidote kit (includes amyl nitrate, Na nitrite, and Na thiosulfate)
Deadly nightshade	Anticholinergic symptoms, hyperthermia, seizures, hallucinations	Supportive care For severe hyperthermia or seizures, possibly physostigmineSome Trade Names No US trade name Click for Drug Monograph
Dieffenbachia (dumbcane)	Oral mucosal damage due to Ca oxalate crystals in leaves	Supportive care and demulsification (eg, with milk or ice cream)
Fava beans	In patients with G6PD deficiency, gastroenteritis, fever, headache, hemolytic anemia	Supportive care For severe anemia and poisoning, consideration of exchange transfusion
Green potato and potato sprout	Gastroenteritis, hallucinations, delirium	Supportive care
Holly berries	Gastroenteritis	Supportive care
Jimsonweed	Anticholinergic symptoms, hyperthermia, seizures, hallucinations	Supportive care For severe hyperthermia or seizures, possibly physostigmineSome Trade Names No US trade name Click for Drug Monograph
Licorice (not the artificially flavored licorice candy)	Hypokalemia, hypertension, and retention of water and Na (pseudohyperaldosteronism)	Supportive
Lily of the valley	Hyperkalemia, gastroenteritis, confusion, arrhythmias	See discussion of digitalis preparations at Heart Failure: Digitalis preparations
Mistletoe	Gastroenteritis	Supportive care
Nettle	Local stinging and burning	Supportive care
Nightshade, common or woody	Gastroenteritis, hallucinations, delirium	Supportive care
Pennyroyal	Hepatotoxicity	N-AcetylcysteineSome Trade Names MUCOMYST Click for Drug Monograph
Philodendron spp	Oral mucosal damage due to Ca oxalate crystals in leaves	Supportive care and demulsification (eg, with milk or ice cream)
Poinsettia	Minor mucous membrane irritation	Unnecessary
Poison ivy	Dermatitis	See Dermatitis
Pokeweed	Mucous membrane irritation, gastroenteritis	Supportive care
Pothos	Oral mucosal damage due to Ca oxalate crystals in leaves	Supportive care and demulsification (eg, with milk or ice cream)
Yew	Gastroenteritis Rarely, seizures, arrhythmias, coma	Supportive care
*Available only in France.
Fab = fractionated antibodies.

Moderately Poisonous Plants

Plant

Symptoms

Treatment

Aconitine (eg, derived from monkshood)	Bradycardia, dysrhythmias, paresthesia, weakness	Supportive care Sodium bicarbonate
Aloe spp	Gastroenteritis, nephritis, skin irritation	Supportive care and irrigation with soap and water
Aristolochia spp (birthworts, pipevines)	Tubulointerstitial nephropathy	Supportive care
Azalea	Cholinergic symptoms	Supportive care and atropineSome Trade Names ATROPEN ATROPINE-CARE SAL-TROPINE Click for Drug Monograph
Caladium spp (elephant ear, angel's wings)	Oral mucosal damage due to Ca oxalate crystals in leaves	Supportive care and demulsification (eg, with milk or ice cream)
Capsicum spp (peppers)	Mucous membrane irritation and swelling	Supportive care, irrigation
ColchicineSome Trade Names No US trade name Click for Drug Monograph (autumn crocus, meadow saffron, glory lily)	Delayed gastroenteritis, multiple organ failure Bone marrow suppression	Supportive care and possibly, as a last resort, experimental colchicineSome Trade Names No US trade name Click for Drug Monograph -specific Fab fragments*
Cyanogenic glycosides (eg, in Prunus spp [eg, peach, apricot, and wild cherry pits], Malus spp [eg, apple seeds],and other seeds)	Symptoms of cyanide poisoning	HydroxocobalaminSome Trade Names CYANOKIT Click for Drug Monograph Cyanide antidote kit (includes amyl nitrate, Na nitrite, and Na thiosulfate)
Deadly nightshade	Anticholinergic symptoms, hyperthermia, seizures, hallucinations	Supportive care For severe hyperthermia or seizures, possibly physostigmineSome Trade Names No US trade name Click for Drug Monograph
Dieffenbachia (dumbcane)	Oral mucosal damage due to Ca oxalate crystals in leaves	Supportive care and demulsification (eg, with milk or ice cream)
Fava beans	In patients with G6PD deficiency, gastroenteritis, fever, headache, hemolytic anemia	Supportive care For severe anemia and poisoning, consideration of exchange transfusion
Green potato and potato sprout	Gastroenteritis, hallucinations, delirium	Supportive care
Holly berries	Gastroenteritis	Supportive care
Jimsonweed	Anticholinergic symptoms, hyperthermia, seizures, hallucinations	Supportive care For severe hyperthermia or seizures, possibly physostigmineSome Trade Names No US trade name Click for Drug Monograph
Licorice (not the artificially flavored licorice candy)	Hypokalemia, hypertension, and retention of water and Na (pseudohyperaldosteronism)	Supportive
Lily of the valley	Hyperkalemia, gastroenteritis, confusion, arrhythmias	See discussion of digitalis preparations at Heart Failure: Digitalis preparations
Mistletoe	Gastroenteritis	Supportive care
Nettle	Local stinging and burning	Supportive care
Nightshade, common or woody	Gastroenteritis, hallucinations, delirium	Supportive care
Pennyroyal	Hepatotoxicity	N-AcetylcysteineSome Trade Names MUCOMYST Click for Drug Monograph
Philodendron spp	Oral mucosal damage due to Ca oxalate crystals in leaves	Supportive care and demulsification (eg, with milk or ice cream)
Poinsettia	Minor mucous membrane irritation	Unnecessary
Poison ivy	Dermatitis	See Dermatitis
Pokeweed	Mucous membrane irritation, gastroenteritis	Supportive care
Pothos	Oral mucosal damage due to Ca oxalate crystals in leaves	Supportive care and demulsification (eg, with milk or ice cream)
Yew	Gastroenteritis Rarely, seizures, arrhythmias, coma	Supportive care
*Available only in France.
Fab = fractionated antibodies.

Last full review/revision February 2013 by Gerald F. O'Malley, DO; Rika O'Malley, MD

Content last modified March 2013

Buy the Book

Previous: Mushroom Poisoning

Next: Fish and Shellfish Poisoning

Audio

Figures

Photographs

Sidebars

Tables

Videos