Cases reported "Plant Poisoning"

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1/119. Angel trumpet lily poisoning in five adolescents: clinical findings and management.

    OBJECTIVE: To describe clinical features and management of Angel trumpet lily poisoning in adolescents. METHODOLOGY: Case notes of five adolescent males who presented to the emergency department of a teaching hospital were reviewed. RESULTS: All five boys ingested a mixture of coca-cola and a brew prepared by boiling the leaves and flowers of the plant. They presented to the emergency department with various degrees of agitation and confusion and specific clinical signs. All were treated with charcoal and cathartics and discharged after 36 h. CONCLUSIONS: Due to its hallucinogenic effects, abuse of Angel trumpet lily is not uncommon and should be suspected in adolescents presenting with altered mental state and hallucinations in conjunction with other anticholinergic symptoms and signs. ( info)

2/119. datura stramonium poisonings in humans.

    datura stramonium is a hallucinogenic plant which causes serious poisoning. Clinical symptoms are those of atropinic intoxication with psychiatric manifestations of dryness of mouth, mydriasis, tachycardia and hallucinations. diagnosis is essentially clinical. Treatment is symptomatic and suppurative; prognosis is usually favorable. ( info)

3/119. Poisoning by plant material: review of human cases and analytical determination of main toxins by high-performance liquid chromatography-(tandem) mass spectrometry.

    The authors have reviewed the main toxic plants responsible for human deaths throughout the world. Forty plants (genera or species) were listed in order to establish an inventory of the active molecules that could be identified, the already published analytical methods and the reported human fatal cases. In a second step, the authors have developed a general method for the detection of various toxins in whole blood by high-performance liquid chromatography coupled to mass spectrometry or tandem mass spectrometry. Sample preparation was realized by liquid-liquid extraction at pH 9.5 for oleandrine, taxol and the alkaloids. These latter compounds were divided into two groups following their chemical properties and could be subsequently purified by acid/base clean up. Cyanogenic compounds and atractyloside were isolated by precipitation of the protein content with acetone and purified for atractyloside by washing with chloroform. Separation of the drugs occurred under reversed-phase conditions on a C18 analytical column 150x2 mm I.D. (5 microm particle size) using two different mobile phases. The first one, formiate buffer 2 mM acidified at pH 3.0, was used for the separation of atractyloside, oleandrine, taxol, the cyanogenic molecules and some alkaloids. The second mobile phase, formiate buffer 10 mM made basic at pH 8.2 was used for the majority of other alkaloids. A gradient elution mode was chosen using acetonitrile or acetonitrile-methanol (50:50, v/v) as the eluting solvent. Detection under positive ionization mode was the mode of choice for all compounds except for atractyloside (negative ions) and for taxol (mixed mode available). Application to real forensic cases has been demonstrated. ( info)

4/119. The spectrum of ocular inflammation caused by euphorbia plant sap.

    OBJECTIVE: To report the spectrum of clinical findings in patients with ocular inflammation caused by plant sap from euphorbia species. DESIGN: Clinical case series. SETTING: ophthalmology emergency referrals in the United Kingdom. patients: We examined 7 patients, all of whom gave a history of recent ocular exposure to the sap of euphorbia species. INTERVENTIONS: All patients were treated with antibiotic drops or ointment (chloramphenicol). Cycloplegic and steroid drops were also used for some patients. patients were observed until all signs and symptoms had resolved. MAIN OUTCOME MEASURES: Symptoms, visual acuity, and clinical signs of inflammation. All patients provided a specimen of the plant for formal identification. RESULTS: Initial symptoms were generally burning or stinging pain with blurred vision. In most cases, visual acuity was reduced between 1 and 2 Snellen lines. In 1 patient with age-related maculopathy, acuity dropped from 20/80 to hand motions before recovering. Clinical findings varied from a mild epithelial keratoconjunctivitis to a severe keratitis with stromal edema, epithelial sloughing, and anterior uveitis. All signs and symptoms had resolved by 1 to 2 weeks. CONCLUSIONS: These cases illustrate the range of severity of euphorbia sap keratouveitis. The condition seems to be self-limiting when managed supportively. People who work with euphorbia plant species should wear eye protection. Clinicians managing keratopathy caused by euphorbia species should be aware of the danger of sight-threatening infection and uveitis, particularly during the first few days. ( info)

5/119. Rare jatropha multifida intoxication in two children.

    Two children were admitted to the Emergency Department (ED) after ingesting a large amount of fruit of a plant identified as jatropha multifida. They were mildly obtunded, had intractable vomiting, and seemed dehydrated. Intravenous fluid replacement and urine alkalinization were initiated. After stabilization, their 5-day hospital stays were uneventful except for a subclinical rise of liver enzymes. jatropha species contain the toxalbumin ricin, which causes severe vomiting and diarrhea, dehydration, shock, and renal and hepatic impairment. ricin also has cardiotoxic and hemolytic effects and several deaths have been documented. Children are attracted by the shape and the color of the jatropha fruits. mortality can be prevented by immediate fluid and electrolyte replacement. ( info)

6/119. Fatal 'Bhang' poisoning.

    A young adult male of about 25 years of age consumed a glass (about 300 ml) of Bhang on the holy occasion of ShivRatri. The deceased died within 24 hours of consuming the Bhang. The deceased had suffered from rheumatic heart disease with multiple valvular involvements. He had also undergone open-heart surgery in the past. Fatality due to Bhang is extremely rare and therefore the case is presented. An attempt is made to review the literature. Bhang is one of the Indian preparations of Indian hemp (cannabis sativa). It is prepared by the wet grinding of the leaves of the plant. The bolus is then consumed in various ways. water is used as a vehicle. In the present case a bolus of about 1 to 2 gm was mixed in a glass of water. ShivRatri is a Hindu festival. On this day prayers are offered to Lord Shiva, who is the god of all evils and poisons. Bhang is a special article, which is offered to Lord Shiva on this auspicious day. Then, the devotees consume it as the God. Gujrat is a dry state (possession, consumption, sale, etc. of alcohol, Bhang, opium and other psychotropic substance, etc. is governed by particular laws), but on the holy occasion of ShivRati, for a day, the law is relaxed for the use of Bhang. In most other parts of the country, particularly, in northern india, it is a common practice to consume various preparations of Indian hemp like Bhang, Charas, Ganja, sweetmeat, etc. The bolus mentioned above is probably the minimum single dose. ( info)

7/119. Cardiovascular glycoside-like intoxication following ingestion of thevetia nereifolia/peruviana seeds: a case report.

    Some plants contain glycoside compounds which determine cardiovascular symptoms similar to those observed after acute toxic digoxin administration. The present case report involves a patient who showed important cardiovascular symptoms following the ingestion of thevetia nereifolia/peruviana seeds. About 30 min after ingestion, a 65-year-old man presented with dizziness, giddiness, numbness and a burning sensation, diarrhea, sweating, vomiting and ECG changes. At the time of admission he presented with tremors; his body temperature was 37 degrees C, and blood analysis gave the following results: K 5.6 mEq/l, myoglobin 176 IU, troponin t 0.10 ng/ml, PO2 69 mmHg, PCO2 37.4 mmHg, pH 7.33, HCO3- 19.9 mEq/l, hemoglobin 14.8 g/dl, saturation 92.5%. echocardiography showed a left ventricle with normal global and segmentary contractility. The following days, the patient showed a reduction, until total resolution, of the atrioventricular block and of the alterations of the ST segment. The ectopic beats also resolved; K value before discharge was 4.4 mEq/l. On the third day, the serum levels of digoxin were 0.15 ng/ml. This case report is important because it describes all the cardiovascular and non-cardiovascular signs of glycoside toxicity in an adult patient who accidentally swallowed only two seeds (non-fatal dose) of thevetia. ( info)

8/119. Intoxication with taxus baccata: cardiac arrhythmias following yew leaves ingestion.

    The use of yew leaves (taxus Baccata) as a means of deliberate self-harm is infrequent. The potent effect of the toxin is primarily cardiac and results in rhythm alterations and ultimately ventricular fibrillation. As there is no known antidote, and classic antiarrhythmic therapy proves to be ineffective, a prompt diagnosis is of great importance as immediate supportive action is the only valuable alternative. This case describes a 43-year-old women who attempted suicide by ingesting the leaves of taxus Baccata. We discuss the effects and the difficulty of treatment associated with yew leaf poisoning. ( info)

9/119. Accidental mydriasis from exposure to Angel's trumpet (Datura suaveolens).

    PURPOSE: To report clinical findings after accidental instillation into the eye of sap from Angel's trumpet (Datura suaveolens). methods: We report findings on seven patients who developed sudden onset of unilateral mydriasis. At least three of them also had ipsilateral cycloplegia and one developed transient tachycardia. RESULTS: The symptoms evolved after ocular exposure to sap from Angel's trumpet, a plant containing natural alkaloids with parasympatholytic properties. Six patients were initially unaware of the cause of their symptoms. In these cases, patient history revealed recent contact with Angel's trumpet. CONCLUSION: Accidental ocular instillation of sap from Angel's trumpet should be noted as a cause of sudden onset of mydriasis in otherwise unaffected patients and also of general symptoms like tachycardia. ( info)

10/119. A case of fatal poisoning with the aconite plant: quantitative analysis in biological fluid.

    In recent years recorded cases of plant poisoning have become rare, this may in part be due to the possibility of plant ingestion not being indicated at the beginning of an investigation. aconitum napellus (aconite, Wolfsbane, Monkshood) is one of the most poisonous plants in the UK. It contains various potent alkaloids such as aconitine, isoaconitine, lycaconitine and napelline. Ingestion of aconitum plant extracts can result in severe, potentially fatal toxic effects. This paper describes the analytical findings in a recent death in the UK. resulting from deliberate ingestion of aconitum napellus extract. The concentrations of aconitine measured by HPLC-DAD in the post mortem femoral blood and urine were 10.8 micrograms/L and 264 micrograms/L, respectively. The aconitine concentration in the ante mortem urine was 334 micrograms/L and was estimated to be 6 micrograms/L in the ante mortem serum. Hence, accidental, suicidal or homicidal poisoning due to the ingestion of plant material remains a possibility and should be borne in mind when investigating sudden or unexplained death. ( info)
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