[One case of acute poisoning with stramonium].

This paper reported 1 case of poisoning caused by stramonium. Cases of Datura poisoning have been reported nationwide, Its effect on the central nervous system of patients is characterized by first excitation and then inhibition, clinical manifestations include decreased gland secretion, dilated pupils, and tachycardia, etc. Its poisoning mechanism is anticholinergic effect, the effect on Peripheral nervous system is to inhibit Parasympathetic nervous system. Hemoperfusion combined with neostigmine anticholinergic therapy at the early stage of poisoning can effectively improve the clinical symptoms of patients in a short time.

Palicourea marcgravii (Rubiaceae) poisoning in cattle grazing in Brazil.

Palicourea marcgravii is the most important poisonous plant of cattle in Brazil. It contains monofluoroacetic acid and causes sudden death associated with exercise. Herein, we describe the temporal and spatial distribution of the toxic disease. The survey was based on the epidemiological, clinical, and pathological data of the Setor de Anatomia Patológica (SAP) of the Universidade Federal Rural do Rio de Janeiro (UFRuralRJ) to report outbreaks of poisoning by P. marcgravii, from 1953 to 2018. Clinical signs were peracute and included labored breathing, loss of balance, muscle tremors, lateral recumbency, and limb paddling. Gross lesions such as congestion of large vessels and edema and pulmonary congestion were observed. Multifocal areas of vacuolar hydropic degeneration of distal contorted tubule cells with nuclear pyknosis were observed in the kidneys. The plant is found in forests, and the poisoning occurs mainly after clearing forests for pasture, in areas of natural forest recovery called "capoeira," which provide a favorable environment for maintaining P. marcgravii growth. Outbreaks of P. marcgravii poisoning coincided with periods of creation of large deforested pastures in the Southeast and Midwest regions of Brazil, and the poisoning should be considered an additional risk after deforestation. The most effective prophylaxis is fencing off the forest areas that contain these plants.

Clinical Toxicology of Yew Poisoning.

OBJECTIVES: Yew plant materials contain highly toxic taxine alkaloids. Serious ingestions can result in life-threatening toxicity. The purpose of this article is to summarize the literature on the treatment of acute yew poisoning. DATA SOURCES: PubMed (January 1946 to November 2017) was searched using the search terms "taxus/po". EMBASE (1980 to November 2017) was searched using the search terms "taxus/to" and "yew.mp." Web of Science (1945 to November 2017) was searched using the text words taxus, taxine, and yew. STUDY SELECTION AND DATA EXTRACTION: Available English language articles involving case reports, epidemiology, treatment, and outcomes were included. DATA SYNTHESIS: Although not uncommon, unintentional yew poisoning rarely results in significant morbidity or mortality. A total of 26 case reports of yew poisoning were evaluated along with 4 case series articles (totaling 22 additional cases). Only 4 of the 48 total cases (8%) were accidental poisonings, the rest being deliberate ingestions. In 20 patients (42%), it resulted in fatalities. Severe, acute yew poisoning results in symptomatology largely resistant to pharmacotherapy intervention. CONCLUSIONS: Most nonintentional ingestions of yew plant constituents are asymptomatic and require little intervention. Severe poisoning can result in life-threatening cardiac toxicity and require aggressive supportive care. Therapeutic interventions, such as sodium bicarbonate, digoxin immune fab, and hemodialysis that have been utilized in case studies and case series in the literature have little proven benefit. Extracorporeal life support should be considered in severe yew poisoning.

Respiratory Failure Due To Plant Poisoning: Nicotiana glauca Graham.

BACKGROUND: Cases of human poisoning associated with Nicotiana glauca Graham are quite rare. Patients may consume the plant by mistaking it for spinach or use it as a folk remedy. The toxin stimulates the acetylcholine receptors in the central and autonomic nervous systems. A prompt and appropriate supportive treatment is crucial for survival. CASE REPORT: A 72-year-old female with a known breast cancer was brought to our emergency department (ED) with complaints of nausea and vomiting. The patient stated that her complaints started 2 h after she had cooked and eaten a plant in the hopes that it would help cure her cancer. On the second hour after arrival, the patient became confused. It was observed that the chest wall movements had decreased and that the patient had difficulty breathing. Due to respiratory failure, orotracheal intubation was performed to secure the airway. A sample of the plant that was eaten was requested from the patient's relatives. According to an Internet search, the plant sample was identified as N. glauca Graham. The patient was diagnosed with N. glauca Graham poisoning. The patient was extubated after 30 h. On 3-month follow-up, the patient was neurologically intact and had no complaints related to poisoning. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patients with incurable diseases such as cancer tend to try folk remedies and can end up in ED. In patients who present with muscle paralysis and respiratory failure, emergency physicians should consider N. glauca Graham as a cause of plant poisoning.

Recurrent Ventricular Arrhythmia Caused by Ingestion of Aconitum (Monkshood) Flowers.

We report the case of a patient who presented with respiratory failure, recurrent ventricular fibrillation, ventricular arrhythmias, and hypotension after an intentional ingestion of aconite flowers. Significant ingestion of this plant can produce life-threatening cardio- and neurotoxicity that may require evacuation from the wilderness to a medical facility capable of advanced treatment and intensive care monitoring.

Datura stramonium intoxication in two children.

Datura stramonium is a toxic plant member of the Solanaceae family. Its consumption may result in severe anticholinergic toxicity. We report the intoxication of 5- and 4-year-old brothers with Datura stramonium, which presented in two different manners. The first child presented agitation, hallucination and mydriasis that improved rapidly with benzodiazepine medication. The second presented comatose, mydriasis and Babinski signs. Gastric lavage and activated charcoal administration were performed. The child was intubated and mechanically ventilated until consciousness improvement. Datura stramonium poisoning may be considered by physicians in case of acute onset of decreased consciousness or behaviour trouble associated with anticholinergic signs and symptoms.

Oropharyngeal airway obstruction after the accidental ingestion of Arisaema amurense.

BACKGROUND: Arisaema amurense is widely known in Korean folklore as a poisonous plant, and its lethal toxicity has long been recognized. The toxicity of Arisaema amurense is due to its content of calcium oxalate, which causes painful oropharyngeal edema, hypersalivation, aphonia, oral ulceration, esophageal erosion, and hypocalcemia. OBJECTIVE: We report a case of accidental poisoning after ingestion of the rhizome of Arisaema amurense, resulting in airway obstruction that required endotracheal intubation. CASE REPORT: A 60-year-old man developed oral pain and swelling after accidentally ingesting a rhizome from the Arisaema amurense plant as a medicinal herb. His symptoms worsened upon his arrival in the Emergency Department, and he was unable to speak due to oral swelling and hypersalivation. The patient underwent endotracheal intubation to protect his airway and was treated with antihistamines and corticosteroids. Three days after treatment, he had improved and was extubated. CONCLUSION: We describe an emergent treatment course for a patient with acute airway obstruction resulting from the ingestion of Arisaema amurense.

Brunfelsia australis (Yesterday, Today, and Tomorrow tree) and Solanum poisoning in a dog.

A 2.5 yr old female beagle presented for acute abdominal pain and vomiting after consuming limited offerings of green potato skins. Progressive complications associated with suspected ingestion of a higher potency toxin followed within 5 hr. Subsequent investigations revealed a significant ingestion of an Australian shrub commonly called a "Yesterday, Today, and Tomorrow" tree (Brunfelsia australis). The toxic principle for this emerging toxicity is referred to as "strychnine-like" and is potentially lethal with gastrointestinal, central nervous system, and cardiac pathology. This plant is currently being aggressively promoted by United States nurserymen for its dramatic tri-colored blooms and drought resistance.

Fatal overdose of Taxus baccata plant matter treated in a rural district general hospital.

A 25-year-old woman presented with cardiogenic shock following intentional overdose of Common Yew (Taxus baccata). The pharmacological mechanisms underlying yew toxicity resulted in failure of multiple treatment modalities including inotropes, vasopressors and attempted pacing. Resuscitation was ultimately unsuccessful. The limited literature available on this kind of overdose suggests that early extracorporeal membrane oxygenation (ECMO) is the mainstay of treatment in severe cases presenting with hypotension and arrhythmias. However, there may be a role for digoxin antibody fragments in maintaining patients presenting to remote sites, to allow transfer to a specialist centre.

Treatment of yew leaf intoxication with extracorporeal circulation.

Taxine, a yew tree toxin, is highly cardiotoxic. We report the case of a patient who developed severe cardiac failure and ventricular fibrillation after consuming yew leaves and who made a full recovery after extracorporeal life support. Yew poisoning can be added to the list of potential indications of extracorporeal life support for refractory toxic cardiogenic shock.

[Poisonous plants]. / Myrkylliset kasvit.

Approximately ten species of dangerously poisonous plants are found in Finland. Severe plant poisonings are very rare. Edible plants eaten raw or wrongly processed may cause severe symptoms. As first aid, activated charcoal should be given to the person who has eaten a plant causing a risk of significant poisoning. In case of exposure to topically irritating plant fluids, the exposed person's eyes must be irrigated and mouth or skin washed with copious amounts of water. In combination with solar UV radiation, light-sensitizing plants cause local burns. The diagnosis of plant poisoning is usually based on incidental information; the plant should be identified in order to make the correct treatment decisions.

Poisonous plants.

A large number of plants can cause adverse effects when ingested by animals or people. Plant toxicity is due to a wide diversity of chemical toxins that include alkaloids, glycosides, proteins and amino acids. There are several notable toxic plants for which a specific chemical responsible for toxicity has not been determined. There are many examples of species differences in terms of their sensitivity to intoxication from plants. Pets, such as dogs and cats, and people, especially children, are frequently exposed to the same toxic plants due to their shared environments. On the other hand, livestock are exposed to toxic plants that are rarely involved in human intoxications due to the unique environments in which they are kept. Fortunately, adverse effects often do not occur or are generally mild following most toxic plant ingestions and no therapeutic intervention is necessary. However, some plants are extremely toxic and ingestion of small amounts can cause rapid death. The diagnosis of plant intoxication can be challenging, especially in veterinary medicine where a history of exposure to a toxic plant is often lacking. Analytical tests are available to detect some plant toxins, although their diagnostic utility is often limited by test availability and timeliness of results. With a few notable exceptions, antidotes for plant toxins are not available. However, general supportive and symptomatic care often is sufficient to successfully treat a symptomatic patient.

[Star fruit (Averrhoa carambola) toxic encephalopathy]. / Encéphalopathie toxique par ingestion de carambole (Averrhoa carambola).

Ingestion of star fruit (Averrhoa carambola) can induce severe intoxication in subjects with chronic renal failure. Oxalate plays a key role in the neurotoxicity of star fruit. We report the cases of two patients with unknown chronic renal insufficiency who developed severe encephalopathy after ingestion of star fruit. The two patients developed intractable hiccups, vomiting, impaired consciousness and status epilepticus. Diffusion-weighted MR imaging showed cortical and thalamic hyperintense lesions related to epileptic status. They improved after being submitted to continuous hemofiltration which constitutes the most effective treatment during the acute phase.

[Intoxications with plants]. / Vergiftungen mit Pflanzen.

Ingestions of plants rarely lead to life-threatening intoxications. Highly toxic plants, which can cause death, are monkshood (Aconitum sp.), yew (Taxus sp.) and autumn crocus (Colchicum autumnale). Lethal ingestions of monkshood and yew are usually suicides, intoxications with autumn crocus are mostly accidental ingestions of the leaves mistaken for wild garlic (Allium ursinum). Severe intoxications can occur with plants of the nightshade family like deadly nightshade (Atropa belladonna), angel's trumpet (Datura suaveolens) or jimsonweed (Datura stramonium). These plants are ingested for their psychoactive effects. Ingestion of plant material by children most often only causes minor symptoms or no symptoms at all, as children usually do not eat great quantities of the plants. They are especially attracted by the colorful berries. There are plants with mostly cardiovascular effects like monkshood, yew and Digitalis sp. Some of the most dangerous plants belong to this group. Plants of the nightshade family cause an anticholinergic syndrome. With golden chain (Laburnum anagyroides), castor bean (Ricinus communis) and raw beans (Phaseolus vulgaris) we see severe gastrointestinal effects. Autumn crocus contains a cell toxin, colchicine, which leads to multiorgan failure. Different plants are irritative or even caustic to the skin. Treatment is usually symptomatic. Activated charcoal is administered within one hour after ingestion (1 g/kg). Endoscopic removal of plant material can be considered with ingestions of great quantities of highly toxic plants. Administration of repeated doses of charcoal (1-2 g/h every 2-4 hours) may be effective in case of oleander poisoning. There exist only two antidotes: Anti-digoxin Fab fragments can be used with cardenolide glycoside-containing plants (Digitalis sp., Oleander). Physostigmine is the antidote for severe anticholinergic symptoms of the CNS. Antibodies against colchicine, having been developed in France, are not available at the moment.

Yew poisoning - pathophysiology, clinical picture, management and perspective of fat emulsion utilization.

The article presents pathophysiology, clinical picture and management of yew poisoning. Authors present also their own experiences with treating yew poisoning with fat emulsion. Plants of the yew genus, of which in Europe predominates Taxus baccata, are well known for their toxic properties. Particularly high concentrations of poisonous alkaloids are present in the needles of this evergreen and highly popular decorative plant. The danger associated with accidental or intentional ingestion of yew is primarily related to the cardiotoxic effects of the alkaloids (taxine A and B). Taxine B shows a much stronger toxic effect on the heart than taxine A. It affects atrio-ventricular conduction, what may result in a widening of the QRS complexes, atrio-ventricular blocks (A-V) of II/III degree and even in asystole. Yew poisoning is relative rare and evidence-based treatment guidelines on management of such poisoning is hard to prepare. The first-line treatement should base on suportive therapy. In some cases extracorporeal life support therapies such veno-arterial ECMO should be consider. There are also premise based on case reports and mechanism of action that the use of fat emulsion may be effective rescue treatment.