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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
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 digoxin 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. Digoxin-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.
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Table 6
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PrintOpen table in new window  |
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| Moderately Poisonous Plants |
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Plant
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Symptoms
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Treatment
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Aconitine (eg, derived from monkshood)
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Bradycardia, dysrhythmias, paresthesia, weakness
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Supportive care
Sodium bicarbonate
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Aloe spp
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Gastroenteritis, nephritis, skin irritation
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Supportive care and irrigation with soap and water
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Aristolochia spp (birthworts, pipevines)
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Tubulointerstitial nephropathy
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Supportive care
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Azalea
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Cholinergic symptoms
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Supportive care and atropine
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Caladium spp (elephant ear, angel's wings)
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Oral mucosal damage due to Ca oxalate crystals in leaves
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Supportive care and demulsification (eg, with milk or ice cream)
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Capsicum spp (peppers)
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Mucous membrane irritation and swelling
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Supportive care, irrigation
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Colchicine (autumn crocus, meadow saffron, glory lily)
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Delayed gastroenteritis, multiple organ failure
Bone marrow suppression
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Supportive care and possibly, as a last resort, experimental colchicine-specific Fab fragments*
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Cyanogenic glycosides (eg, in Prunus spp [eg, peach, apricot, and wild cherry pits], Malus spp [eg, apple seeds],and other seeds)
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Symptoms of cyanide poisoning
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Hydroxocobalamin
Cyanide antidote kit (includes amyl nitrate, Na nitrite, and Na thiosulfate)
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Deadly nightshade
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Anticholinergic symptoms, hyperthermia, seizures, hallucinations
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Supportive care
For severe hyperthermia or seizures, possibly physostigmine
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Dieffenbachia (dumbcane)
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Oral mucosal damage due to Ca oxalate crystals in leaves
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Supportive care and demulsification (eg, with milk or ice cream)
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Fava beans
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In patients with G6PD deficiency, gastroenteritis, fever, headache, hemolytic anemia
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Supportive care
For severe anemia and poisoning, consideration of exchange transfusion
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Green potato and potato sprout
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Gastroenteritis, hallucinations, delirium
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Supportive care
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Holly berries
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Gastroenteritis
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Supportive care
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Jimsonweed
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Anticholinergic symptoms, hyperthermia, seizures, hallucinations
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Supportive care
For severe hyperthermia or seizures, possibly physostigmine
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Licorice (not the artificially flavored licorice candy)
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Hypokalemia, hypertension, and retention of water and Na (pseudohyperaldosteronism)
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Supportive
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Lily of the valley
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Hyperkalemia, gastroenteritis, confusion, arrhythmias
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See discussion of digitalis preparations at Heart Failure: Digitalis preparations
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Mistletoe
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Gastroenteritis
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Supportive care
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Nettle
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Local stinging and burning
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Supportive care
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Nightshade, common or woody
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Gastroenteritis, hallucinations, delirium
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Supportive care
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Pennyroyal
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Hepatotoxicity
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N-Acetylcysteine
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Philodendron spp
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Oral mucosal damage due to Ca oxalate crystals in leaves
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Supportive care and demulsification (eg, with milk or ice cream)
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Poinsettia
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Minor mucous membrane irritation
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Unnecessary
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Poison ivy
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Dermatitis
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See Dermatitis
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Pokeweed
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Mucous membrane irritation, gastroenteritis
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Supportive care
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Pothos
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Oral mucosal damage due to Ca oxalate crystals in leaves
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Supportive care and demulsification (eg, with milk or ice cream)
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Yew
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Gastroenteritis
Rarely, seizures, arrhythmias, coma
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Supportive care
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*Available only in France.
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Fab = fractionated antibodies.
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Last full review/revision February 2013 by Gerald F. O'Malley, DO; Rika O'Malley, MD
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