Plants, Mushrooms, and Herbal Remedies

Plants

Most dangerous Oleander, Jimson Weed, Jequirty Pea, Water Hemlock, Poison Hemlock, Monkshood

Ackee Fruit

Jamaica and southern US. Poisonous when unripe (must be splitting open to be ripe) Jamaican vomiting sickness, hypoglycemia, or hepatotoxicity Toxin impairs hepatic gluconeogenesis and fatty acid metab in liver Give glucose, possibly L-Carnitine

Chili Pepper

Capsaicin exposure Vinegar Coca Cola 50 % Sucrose/50%Fructose dissolved in Milk Baby Shampoo Works by nerve stimulation, not direct damage

Dumbcane

Mother-in-law’s tongue, poisonous arum, dieffenbachia Calcium oxalate crystals If eaten, immediate pharyngeal reaction Ocular exposure results in immense pain, conjunctivitis, abrasions If resp compromise will develop, it will be in the first 6 hours

Devil’s Ivy

Calcium oxalate in plant parts Gi and ocular exposure similar to dumbcane exposure Contact dermatitis

Hemlocks

People think poison hemlock is wild carrot or use water hemlock as a pea shooter or straw Cicutoxin causing cns stimulation, seizures, tachycardia then bradycardia and paralysis AC, Benzos, Supportive care

Holly

Gi sx Supportive care

Jade Plant

No toxin

Jimsonweed

Devil’s apple, stinkweed Tropane alkaloids (atropine, scopolamine, etc.), aka belladonna Also contained in henbane, nightshade, belladonna, mandrake ACh poisoning Activated charcoal, benzos, consider physiostigmine

Oleander

Cardiac glycosides (like dig) Others that contain same: dogbane, foxglove, lily of the valley

Dysrhythmias AC, Consider Digibind,

Poison Ivy

Can get same sx from mango rind or cashew nut shells Must have prior sensitization Topical steroids, if severe systemic steroids

Rosary Pea and Castor Bean

Ricinus seeds are brown and speckled, rosary peas are bright red Abrin and ricin respectively, toxalbumins, inhibit cellular protein synthesis

Mushrooms

Group I

Cyclopeptide Containing Species (Amanita, Galerina, and Lepiota) Potent inhibitors of protein synthesis, lead to hepatorenal failure Onset 6-24 hours If high suspicion, AC, PCN 1 million U/kg/day, Hemoperfusion ? Thioctic acid, cimetidine, IV NAC (Unpublished report in Italy of 11 patients, none died, 1 needed transplant), Silibinin Cr > 1.2 on postingestion day 2=large mortality and probable need for liver transplant

Group VI

Psilocybin Onset 30-60 minutes

LSD like effects

Group IX

Allenic Norleucine, (Pacific Northwest) Amanita Smithiana Causes GI sx in ~30 minutes but can be lethal, the exception to the rule of 6 hour observation Renal failure Unlike other toxic mushrooms, sx may begin immediately

Coprine Containing Mushrooms

C. atramentarius causes a disulfuram-like effect

Muscarine

The non-lethal mushrooms usually cause gi effects in 30-60 minutes. Their effects are sometimes from muscarine, therefore atropine can be used in severe cases. Other times non-specific gi toxins.

Empirical Management

Gauge toxicity by time to emesis. Less than 6 hours is good, usually not toxic. Consult if mixed ingestion or late onset of symptoms  

Herbal Remedies

EM Practice Herbal Supplements   Table 1. Marketing Of Common Herbal Supplements.   Herbal agent Marketed as/also called Claimed benefits Components Comfrey   Marketed for treatment of fractures, tendon injuries, gastrointestinal tract ulcerations, and lung congestion Pyrrolizidine alkaloids Ephedra Ma huang; brand names include Metabolife®, Ripped Fuel®, Ultimate Orange, Purple Blast, and Yellow Jackets Marketed as weight loss aids, stimulants, energy boosters, and exercise enhancers Up to 90% ephedrine, also pseudoephedrine and norephedrine (some preparations may include other herbal additives, caffeine, and various stimulants) Ginkgo biloba   Marketed to boost cognitive abilities (especially in Alzheimer’s disease and other dementias), treat peripheral vascular disease, vertigo, tinnitus, altitude sickness, erectile dysfunction, and age-related macular degeneration. Flavonoids which resemble folic acid and possess free radical scavenging properties, and terpenoids Ginseng Panax Marketed to treat sexual dysfunction, cardiovascular disease, immune suppression, and cancer, in addition to enhancing cognitive and physical performance   Kava kava Kava, ava, kawa Marketed to relieve insomnia, induce deep sleep, enhance psychic powers, and promote a sense of sociability Kavalactones St. John’s wort Hypericum perforatum Marketed to relieve depression/anxiety, occasionally to promote wound healing Hyperforin, hypericin, a broad range of flavonoids, and tannins Valerian Valerian officinalis Marketed as a sleep aid Volatile oils and valepotriates     Table 2. Possible Adverse Effects Of Some Specific Herbal Supplements.   Herbal agent Most frequently reported adverse effects Possible/more dangerous complications Comfrey Hepatotoxicity Hepatic insufficiency or fulminant hepatic failure Ephedra Headache, nausea, vomiting, diaphoresis, insomnia, vertigo, agitation, psychosis, hypertension, tachycardia, palpitations, seizures, tremors, and rhabdomyolysis Sudden death, myocardial infarction, stroke, myocarditis, acute hepatitis Ginkgo biloba Gastric upset, headache, dermatitis; sometimes erythema, edema, papules, vesicles complicated by pruritus Seizures, temporally related hemorrhages, hemorrhagic strokes Ginseng Mania/euphoria; also diarrhea, skin eruptions, nervousness, hypertension, edema, vaginal bleeding, falsely elevated digoxin levels   Kava kava Dermatologic (“kava dermopathy”), neurologic, and liver dysfunction Hepatitis, cirrhosis, and liver failure St. John’s wort Photosensitivity, gastrointestinal complaints, dizziness, and headache Serotonin syndrome Valerian CNS sedation Hepatotoxicity     Ephedra Mostly ephedrine or precursors of ephedrine Aka ma huang cardiac toxicity   Ginkgo Biloba Flavonoids Gi upset, Headache, and Dermatitis May cause seizures Bleeding disorders secondary to inhibition of platelet activating factor   Kava Kava advertised to treat insomnia, serotonin and nor-epi uptake blockade, weak gaba, sodium channels, MAOI, and dopamine receptor blockade scaling white rash spreading from head to feet rarely can cause severe liver damage   St. John’s Wort Hypericum perforatum for sleep, anxiety, and depression Probably has MAOI and gaba effects May be associated with serotonin syndrome Also hypomanic and manic episodes   Ginseng For sexual dysfunction and to enhance physical performance Drug-drug interactions with dig   Valerian For insominia and agitation Liver toxicity   Comfey Hepatotoxin     Table 5. Heavy Metal Adulterants Found In Some Herbal Supplements.   Agent Type Contaminant Alarcon Traditional/folk remedy Lead Alkohl Traditional/folk remedy Lead Ayurvedic metal-mineral tonics Traditional/folk remedy Lead Azarcon Traditional/folk remedy Lead Bali goli Traditional/folk remedy Lead Coral, coral calcium Traditional/folk remedy Lead Crocodile Bile Pills for Asthma Asian remedy Arsenic, lead Crude Red Pills Asian remedy Arsenic, lead Crude Tan Pills Asian remedy Arsenic, lead Deshi Dewa (fertility drug) Traditional/folk remedy Lead Gliasard Traditional/folk remedy Lead Greta Traditional/folk remedy Lead Hai ge fen (clamshell powder) Traditional/folk remedy Lead Kohl Traditional/folk remedy Lead Liga Traditional/folk remedy Lead Paylooah Traditional/folk remedy Lead Pilulae Corticis Eucommiae et Ossis Tigris Asian remedy Lead, mercury Precious Pills for Women Asian remedy Lead, mercury Reinforce Sex Pill Asian remedy Lead, mercury Rueda Traditional/folk remedy Lead Surma Traditional/folk remedy Lead Wuchi Chi Pai Feng Wan Asian remedy Lead, mercury Yang Chun Yu Ye Kou Fu Ye Asian remedy Lead, mercury                 | | |