Herbal Toxicity

Aka: Herbal Toxicity, Poisonous Plant, Toxic Plant, Toxic Plant Ingestion

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II. Precautions

  1. Patient should report adverse effects to physician
  2. Notify FDA of adverse effects
    1. FDA MedWatch
      1. http://www.fda.gov/medwatch/
      2. Phone: 1-800-332-1088

III. Causes: Cardiovascular Toxicity

  1. See Herbals Affecting Blood Pressure
  2. Cardiac Glycoside Overdose (Digitalis effect)
    1. Aconite (Monkshood)
      1. Used in Traditional Chinese Medicine
      2. Effects Sodium channels with risk of ventricular Arrhythmia (including Ventricular Tachycardia)
    2. Almendra de quema grasa
    3. Asclepias sp. (milkweed)
    4. Cerbera odollam (Suicide tree, pong-pong)
    5. Colorado River Toad
    6. Convallaria majalis (Lily of the valley)
    7. Digitalis (Foxglove)
      1. Digitalis purpurea (Purple foxglove)
      2. Digitalis lanata (Woolly foxglove)
    8. Oleander
      1. Common oleander (Nerium oleander)
      2. Yellow oleander (Thevetia peruviana) has lethal levels of cardiac glycosides in 1-2 nuts
    9. Strophanthus gratus (Ouabain)
    10. Taxus baccata (yew)
      1. Taxine alkaloids affect Sodium and Calcium channels
  3. Strong Stimulants (result in ED visits for Palpitations, Chest Pain)
    1. See Ephedra and Caffeine
    2. Guarana
    3. Yerba mate
    4. Kola nut
    5. Bitter Orange
    6. Yohimbine

IV. Causes: Gastrointestinal Toxicity

  1. GI Irritation (e.g. Nausea, Vomiting, Abdominal Pain)
    1. Philodendron
    2. Dieffenbachia
    3. Phytolacca Americana (pokeweed)
    4. Wisteria
    5. Daphne laureola (spurge laurel)
    6. Ranunculus (buttercup)
    7. Narcissus (daffodil)
    8. Abrus precatorius (rosary pea)
    9. Ricinus communis (castor bean)
  2. Hepatotoxicity
    1. See Hepatotoxin
  3. Laxative abuse risk
    1. Buckthorn bark
    2. Senna
    3. Dock roots
    4. Aloe vera

V. Causes: Neuropsychiatric Toxicity

  1. Anticholinergic: Muscarinic Antagonist (Atropine-like effects)
    1. Atropa belladonna (deadly nightshade)
    2. Amanita muscaria mushrooms
    3. Devil's Apple (Solanum linnaeanum)
    4. Brugmansia species (e.g. angel's trumpet)
    5. Datura stramonium (Jimson weed, thorn apple, Devil's Trumpet)
      1. High concentrations of Atropine, Hyoscyamine, and Scopolamine (esp. in seeds)
      2. Chan (2002) Perm J 6(4): 28-30 [PubMed]
        1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220643/
    6. Garrya species (e.g. silk tassel)
    7. Hyoscyamus niger (henbane, stinking nightshade)
    8. Mandragora officinarum (mandrake)
  2. Anticholinergic: Nicotinic Antagonist
    1. Nicotiana (wild Tobacco)
    2. Laburnum (golden chain tree)
    3. Conium Maculatum (Poison Hemlock)
  3. Hallucinogens or Altered Mental Status
    1. Morning Glory
    2. Hawaiian Baby Woodrose
    3. Catnip
    4. Juniper
    5. Lobelia
    6. Wormwood
    7. Nutmeg
    8. Rhododendron (including Azaleas) contain grayanotoxins
  4. Seizures
    1. Nicotine
      1. Status Epilepticus
      2. Paralysis with large ingestions
    2. Cicuta (Water Hemlock)
      1. Status Epilepticus with even small ingestions

VI. Causes: Miscellaneous Toxicity

  1. Cyanide Poisoning risk with seeds, bark, or leaves (toxicity typically requires large quantity ingestion)
    1. Apricot (or apricot pits/kernels/seeds)
    2. Cassava beans
    3. Cherries
    4. Choke cherries
    5. Crab apple (malus sylvestris)
    6. Hydrangea
    7. Sambucus (elderberry)
    8. Peaches
    9. Plums (prunus)
    10. Pears (pyrus)
    11. Apple (Malus)
  2. Allergic Reaction Risk for those with ragweed allergy
    1. Goldenrod
    2. Marigold
    3. Yarrow
    4. St. John's Wort
    5. Chamomile (or Mayweed or dog fennel)
  3. Abortion risk in pregnancy
    1. Devil's claw root
    2. Barberry
    3. Dong Quai
    4. High concentrations of Ruta, Hydrastis or Oregano
  4. Bleeding risk (Anticoagulant activity)
    1. Ginkgo Biloba
    2. Feverfew
    3. Garlic
    4. Ginseng
    5. Dong Quai
    6. Red Clover
  5. Local Reactions
    1. Araceae Toxicity
      1. Pain and swelling of mucosa on biting leaf (due to sharp, lancinating Calcium oxalate crystals)

VII. Causes: Common Non-Toxic Plants (in small ingestions)

  1. Asparagus setaceus (asparagus fern)
  2. Begonia
  3. Bellis perennis (daisy)
  4. Cactaceae (cactus)
  5. Gardenia jasminoides (gardenia)
  6. Hemerocallis (daylily)
  7. Impatiens
  8. Lilium lancifolium (tiger lily)
  9. Lilium longiflorum (easter lily)
  10. Magnolia
  11. Nephrolepis exaltata (boston fern)
  12. Petunia
  13. Rosa (rose)
  14. Salix babylonica (weeping willow, although does contain Salicylates)
  15. Tagetes (marigold)
  16. Taraxacum (dandelion)
  17. Viola (violet)

VIII. Management

  1. See ABC Management
  2. See Toxin Ingestion
  3. Gather names, pictures, descriptions of most likely ingestions
  4. Consult poison control
  5. Give Activated Charcoal if early presentation after Toxic Plant Ingestion (first few hours) if no contraindications
  6. Monitoring and supportive care
  7. Asymptomatic patients may be discharged after a time after ingestion as specified by poison control

IX. References

  1. Claudius, Behar and Nordt in Herbert (2020) EM:Rap 20(9): 5-7
  2. Tagliaferro (2023) Crit Dec Emerg Med 37(1): 21-9
  3. (2015) Presc Lett 22(12): 70
  4. Asher (2017) Am Fam Physician 96(2): 101-7 [PubMed]

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