Poisoning by poisonous plants: symptoms, diagnosis, treatment

A small number of common plants are poisonous. Highly toxic and potentially fatal plants include castor oil plant, prayer grass, poison hemlock, water hemlock, oleander, and foxglove, which contain glycosides. Specific antidotes are known for a small number of plant poisons.

Moderately poisonous plants

Plant	Symptoms	Treatment
Aloe	Gastroenteritis, nephritis, skin irritation	Supportive care and washing with soap and water
Azalea	Cholinergic symptoms	Supportive care and atropine
Cacti	Infection, granuloma formation	Removing thorns
Caladium	Damage to the oral mucosa by residual calcium oxalate crystals	Supportive treatment and binding of the toxic substance (with milk or ice cream)
Pepper	Irritation of mucous membranes and swelling	Supportive treatment, washing and, if possible, binding of the toxic substance
Colchicine (autumn saffron, meadow saffron)	Delayed gastroenteritis, multiple organ failure	Maintenance therapy and colchicine-specific fractionated antibodies*
Belladonna	Anticholinergic symptoms, hallucinations	Supportive care; physostigmine is given for severe hyperthermia or seizures
Dieffembachia (dumb stick)	Damage to the oral mucosa by residual calcium oxalate crystals	Supportive treatment and binding of the toxic substance (with milk or ice cream)
Fava beans (horse beans)	In patients with glucose-6-phosphate dehydrogenase deficiency: gastroenteritis, fever, headache, hemolytic anemia	Supportive care; in severe poisoning and anemia, consider exchange transfusion
Green potatoes or potato shoots	Gastroenteritis, hallucinations,	Supportive care
Holly berries	Gastroenteritis	Supportive care
Datura stinking	Anticholinergic symptoms, hallucinations	Supportive care; in severe hyperthermia or convulsions - physostigmine
Meadow lily	Hyperkalemia, arrhythmias	See the description of digitalis preparations in the relevant section
Mistletoe	Gastroenteritis	Supportive care
Nettle	Local itching and burning	Supportive care
Datura stramonium or wood thorn apple	Gastroenteritis, hallucinations,	Supportive care
Philodendron spp.	Damage to the oral mucosa by residual calcium oxalate crystals	Supportive treatment and binding of the toxic substance (with milk or ice cream)
Beautiful spurge	Minor irritation of mucous membranes	No need
Poison Ivy	Dermatitis	See Chapter 114
Phytolacca americana	Irritation of mucous membranes, gastroenteritis	Supportive care
Epipremnum	Damage to the oral mucosa by remaining calcium oxalate crystals	Supportive treatment and binding of the toxic substance (with milk or ice cream)
Yew	Gastroenteritis; rarely - arrhythmia, convulsions, coma	Supportive care

*Not available outside France.

Castor oil plants contain ricin, a highly concentrated poison in a relatively impenetrable shell. The seeds must be chewed to release the ricin and cause poisoning. Castor oil plants also contain a concentrated cellular poison that can be fatal if the seeds are ingested, even a single seed in children. Symptoms of poisoning include gastroenteritis, which develops after a latent period, often severe and hemorrhagic, with delirium, convulsions, coma, and death. Colon lavage may be recommended to remove all ingested fruit.

Oleander, foxglove, and other similar but less toxic liliaceae may cause gastroenteritis, confusion, hyperkalemia, and arrhythmias. Plasma digoxin levels may confirm poisoning, but quantitative analysis is not possible. Close monitoring of blood K ⁺ concentrations is necessary. Hyperkalemia may require hemodialysis because of resistance to other treatments. Calcium supplements are not recommended for the treatment of arrhythmias. Digoxin-specific fractionated antibody fragments may be used to treat ventricular arrhythmias.

In case of poisoning with hemlock, symptoms develop within 15 minutes. Poison hemlock activates H-cholinergic receptors in the body, causing dry mouth, tachycardia, tremor, excessive sweating, mydriasis, convulsions, muscle paresis. Bradycardia and rhabdomyolysis may occur. Water hemlock increases the activity of γ-aminobutyric acid, symptoms - gastroenteritis, delirium, refractory convulsions, coma.

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