Poisoning by Medical Plants.

BACKGROUND: Herbal medications are becoming increasingly popular with the impression that they cause fewer side effects in comparison with synthetic drugs; however, they may considerably contribute to acute or chronic poisoning incidents. Poison centers receive more than 100000 patients exposed to toxic plants. Most of these cases are inconsiderable toxicities involving pediatric ingestions of medicinal plants in low quantity. In most cases of serious poisonings, patients are adults who have either mistakenly consumed a poisonous plant as edible or ingested the plant regarding to its medicinal properties for therapy or toxic properties for illegal aims. METHODS: In this article, we review the main human toxic plants causing mortality or the ones which account for emergency medical visits. Articles addressing "plant poisoning" in online databases were listed in order to establish the already reported human toxic cases. RESULTS: The current review introduces herbal plants toxicity and herb-drug interactions to warn the health professionals about possible consequences of unconscious uses of medicinal plants. The reported cases extracted from our prepared database were classified on the basis of the main toxic effects of plants, and the most prominent constituents of the plants which are responsible for specific toxic effects. CONCLUSION: Considering the long history of consumption of herbal medicines in different societies, people may wrongly think that medicinal plants are fully harmless and nontoxic. Prescription, preparation and consumption regulations of medicinal plants are not clear and strict as well as their marketing regulations that differ from country to country. The extensive and various consumption of medicinal plants without adequate observation is the most important reason for poisoning by medicinal plants.

Eucalyptus oil poisoning: two case reports.

BACKGROUND: Eucalyptus oil poisoning is rare in adults but is not that uncommon in children. The common side effects in children include depression in the level of consciousness, ataxia, seizures, and vomiting. Unlike in children, seizures are unusual in adult patients with eucalyptus oil poisoning. We report the cases of two patients with eucalyptus oil poisoning, both adults who unintentionally took eucalyptus oil and presented to the emergency room of our institution with seizures. CASE PRESENTATION: Two adult Indian men who unintentionally consumed eucalyptus oil presented to the emergency room of our institution with seizures. In both patients, arterial blood gas analysis showed the presence of severe metabolic acidosis. Both the patients were managed in the intensive care unit and received standard supportive care. Metabolic acidosis was corrected with intravenous bicarbonate infusion. They were successfully discharged on the fourth day. CONCLUSIONS: All physicians should be aware of the toxic effects of eucalyptus oil, which is used often in daily life in India. Supportive care in an intensive care unit, including rapid correction of metabolic acidosis and adequate maintenance of hemodynamic parameters, will lead to a rapid recovery. Warning labels should be made mandatory on all products that contain eucalyptus oil.

Datura and Brugmansia plants related antimuscarinic toxicity: an analysis of poisoning cases reported to the Taiwan poison control center.

INTRODUCTION: Datura and Brugmansia plants, especially Datura species, have been used for their hallucinogenic effects in the United States and Europe; whereas Datura plants have been used as a traditional medicine in many Asian countries. This study was conducted to better understand the pattern and outcome of Datura/Brugmansia plant related poisoning in Taiwan. METHODS: This is a retrospective case series study of all cases with Datura/Brugmansia exposure reported to the Taiwan Poison Control Center between 1986 and 2015. Data for patients with relevant poisoning were reviewed and abstracted. Logistic regression analysis was used to identify potential predictors of the severity of poisoning; bivariate analysis was employed to assess the effectiveness of physostigmine in the treatment of Datura/Brugmansia poisoning. RESULTS: A total of 203 cases involving 114 Datura exposures and 89 Brugmansia suaveolens exposures were eligible for analysis. Using Datura/Brugmansia for a medicinal purpose by the patients without consulting Chinese medicine practitioners was the most common reason of poisoning (81.2%); whereas only 2% of the patients were poisoned after medicinal use associated with the prescription from Chinese medicine practitioners. None of the 203 patients had used Datura/Brugmansia plant for recreational purpose. Most frequently observed clinical effect was mydriasis (53.2%), followed by confusion (40%), tachycardia (35.5%), dry mouth (35.5%), dizziness (34%), dry skin (32.5%), and delirium (31%). Seventy-three cases (36%) had severe effects; none of them died. Misidentification of the plants and ingestion of plant parts other than flowers were positively associated with the severity of poisoning. Forty patients (19.7%) received physostigmine therapy and patients receiving physostigmine had an earlier resolution of central nervous system toxicity than those who did not. CONCLUSIONS: Medicinal use without consulting Chinese medicine practitioners is the main reason for Datura/Brugmansia poisoning in Taiwan. Consumption of parts other than flowers and misidentification of the plants predicted the severity of poisoning in this study. Patients who received physostigmine appear to have earlier improvement in the central nervous system effects. No adverse events were reported from physostigmine administration.

The Poisoning Information Database Covers a Large Proportion of Real Poisoning Cases in Korea.

The poisoning information database (PIDB) provides clinical toxicological information on commonly encountered toxic substances in Korea. The aim of this study was to estimate the coverage rate of the PIDB by comparing the database with the distribution of toxic substances that real poisoning patients presented to 20 emergency departments. Development of the PIDB started in 2007, and the number of toxic substances increased annually from 50 to 470 substances in 2014. We retrospectively reviewed the medical records of patients with toxic exposure who visited 20 emergency departments in Korea from January to December 2013. Identified toxic substances were classified as prescription drug, agricultural chemical, household product, animal or plant, herbal drug, or other. We calculated the coverage rate of the PIDB for both the number of poisoning cases and the kinds of toxic substances. A total of 10,887 cases of intoxication among 8,145 patients was collected. The 470 substances registered in the PIDB covered 89.3% of 8,891 identified cases related to poisoning, while the same substances only covered 45.3% of the 671 kinds of identified toxic substances. According to category, 211 prescription drugs, 58 agricultural chemicals, 28 household products, and 32 animals or plants were not covered by the PIDB. This study suggested that the PIDB covered a large proportion of real poisoning cases in Korea. However, the database should be continuously extended to provide information for even rare toxic substances.

The Poisoning Information Database Covers a Large Proportion of Real Poisoning Cases in Korea

The poisoning information database (PIDB) provides clinical toxicological information on commonly encountered toxic substances in Korea. The aim of this study was to estimate the coverage rate of the PIDB by comparing the database with the distribution of toxic substances that real poisoning patients presented to 20 emergency departments. Development of the PIDB started in 2007, and the number of toxic substances increased annually from 50 to 470 substances in 2014. We retrospectively reviewed the medical records of patients with toxic exposure who visited 20 emergency departments in Korea from January to December 2013. Identified toxic substances were classified as prescription drug, agricultural chemical, household product, animal or plant, herbal drug, or other. We calculated the coverage rate of the PIDB for both the number of poisoning cases and the kinds of toxic substances. A total of 10,887 cases of intoxication among 8,145 patients was collected. The 470 substances registered in the PIDB covered 89.3% of 8,891 identified cases related to poisoning, while the same substances only covered 45.3% of the 671 kinds of identified toxic substances. According to category, 211 prescription drugs, 58 agricultural chemicals, 28 household products, and 32 animals or plants were not covered by the PIDB. This study suggested that the PIDB covered a large proportion of real poisoning cases in Korea. However, the database should be continuously extended to provide information for even rare toxic substances.

Contribution of plants and traditional medicines to the disparities and similarities in acute poisoning incidents in Botswana, South Africa and Uganda.

BACKGROUND: Acute poisoning incidents are one of the leading causes of morbidity and hospitalization in several countries. The purpose of this analysis was to compare the patterns of acute poisoning in three countries namely, Botswana, South Africa and Uganda; and examine the similarities and disparities in the patterns of occurrence of acute poisoning based on the sociodemographic factors of the victims, the toxic agents involved, the circumstances surrounding the incidents and their outcomes. MATERIALS AND METHODS: This paper is based on the re-analysis of data that were collected from January to June 2005 by some Master of Public Health students using a similar data collection tool. A single dataset made of the original individual datasheets was constituted and analysed. RESULTS: Overall, it was found that the mean age of victims of acute poisoning was 20.9 ± 14.5 years; the youngest victim was a 3 months old boy from South Africa; and the oldest was a 75 years old man from Uganda. In descending order, the most common toxic agents involved in poisoning incidents were household products (46.1%), agrochemicals (18.8%), pharmaceuticals (14.0%), animal and insect bites (13.0%), food poisoning (4.5%), as well as plants and traditional medicines (3.6%). Across the three countries, acute poisoning occurred mainly by accident, but the contextual factors of each country led to a pattern of acute poisoning that showed some similarities with regard to the distribution of deliberate self-poisoning among females, teenagers, and young adult victims. There were disparities related to the differential access to toxic agents, based on the age and gender of the victims. Of the 17 deaths reported, 2 (11.7%) were due to traditional medicines; household products were implicated in fatal outcomes in all three countries, though the extent of their involvement varied from country to country. CONCLUSION: Although plant and traditional medicines caused fewer cases of acute poisoning incidents, they contributed considerably to fatal outcomes.

Intoxicaciones agudas por plantas tóxicas reportadas por Centro de Toxicología de Villa Clara en período 2008-2011 / Acute poisoning by toxic plants as reported by Villa Clara Toxicology Center, 2008-2011

INTRODUCCIÓN: a nivel mundial la exposición accidental o voluntaria a sustancias tóxicas es causa frecuente de intoxicación. En reportes estadísticos predominan las intoxicaciones por psicofármacos y plaguicidas, pero las plantas tóxicas también son frecuentemente consultadas en los servicios de urgencias. OBJETIVO: caracterizar el comportamiento de las intoxicaciones agudas por plantas tóxicas en cuanto a incidencia y morbilidad, reportadas por Centro de Toxicología de Villa Clara (CENTOX-VC), e identificar los tipos de plantas causales, lugar de procedencia del paciente intoxicado y tipo de intoxicación más frecuente. MÉTODOS: se realizó un estudio observacional, descriptivo, retrospectivo en el Centro de Toxicología Clínica de Villa Clara, Cuba, durante los cuatro primeros años de su creación (2008-2011), considerando variables como edad, municipio y/o provincia, planta tóxica responsable, causas de la intoxicación y vías de exposición. RESULTADOS: se atendieron 70 pacientes intoxicados en la consulta de urgencia por plantas tóxicas (8,22 %). Hubo mayor incidencia en el año 2009 con 47 pacientes (67,1 %). Predominó el rango de edad entre 5 y 14 años, el sexo masculino (57,1 %); las intoxicaciones más frecuentes fueron por nuez o nogal (Aleurites trilobus J.R. Forst. & G. Forst) (52,9 %), piñón de botija (Jatropha curcas L) (14,3 %), salvadera (Hura crepitans L) y yuquilla (Cycas circinalis L) (12,9 %) y (10 %) respectivamente. Predominaron las intoxicaciones no intencionales (94,3 %) y la vía de exposición digestiva (95,8 %). Cifuentes fue el municipio de mayor incidencia con 37 pacientes (52,8 %). CONCLUSIONES: la caracterización en nuestro estudio de la incidencia y morbilidad expuesta, así como ser el sexo masculino, grupos etarios (niños y adolescentes) los más afectados por las intoxicaciones agudas de forma no intencional por vía digestiva, brinda conocimientos e información para los profesionales de la salud en el manejo de estos pacientes, debiéndose continuar con su estudio, y realizar labores de divulgación para disminuir su morbilidad.

INTRODUCTION: accidental or intentional exposure to toxic substances is a frequent cause of poisoning worldwide. Statistical reports show a predominance of poisoning by psycholeptics and pesticides, but poisoning by toxic plants is also frequently treated at emergency services. OBJECTIVE: characterize the incidence and morbidity of acute poisoning by toxic plants as reported by Villa Clara Toxicology Center (CENTOX-VC) and identify the types of causal plants, place of residence of the poisoned patient and most frequent poisoning type. METHODS: an observational retrospective descriptive study was conducted at Villa Clara Clinical Toxicology Center in Cuba during the four years following the founding of the Center (2008-2011). The variables considered were age, municipality and/or province, causal toxic plant, causes of the poisoning episode and manner of exposure. RESULTS: seventy patients were cared for at the emergency service for poisoning by toxic plants (8.22 %). The highest incidence was found in the year 2009 with 47 patients (67.1 %). There was a predominance of the 5-14 age range and the male sex (57.1 %). The most frequent causal agents were walnut tree (Aleurites trilobus J. R. Forst. & G. Forst) (52.9 %), physic nut (Jatropha curcas L.) (14.3 %), sandbox tree (Hura crepitans L.) (12.9%) and queen sago (Cycas circinalis L.) (10 %). A predominance was observed of unintentional poisoning (94.3 %) and oral intake (95.8 %). The highest incidence was found in the municipality of Cifuentes with 37 patients (52.8 %). CONCLUSIONS: a characterization is provided of poisoning by toxic plants which includes reference to its incidence and morbidity, the groups most frequently affected (children and adolescents and the male sex), and manner of exposure (unintentional by oral intake). These contents will be useful to health professionals managing poisoning episodes. Further studies should be conducted and dissemination activities performed with a view to reducing the morbidity of these events.

Intoxicaciones agudas por plantas tóxicas reportadas por Centro de Toxicología de Villa Clara en período 2008-2011 / Acute poisoning by toxic plants as reported by Villa Clara Toxicology Center, 2008-2011

Introducción: a nivel mundial la exposición accidental o voluntaria a sustancias tóxicas es causa frecuente de intoxicación. En reportes estadísticos predominan las intoxicaciones por psicofármacos y plaguicidas, pero las plantas tóxicas también son frecuentemente consultadas en los servicios de urgencias. Objetivo: caracterizar el comportamiento de las intoxicaciones agudas por plantas tóxicas en cuanto a incidencia y morbilidad, reportadas por Centro de Toxicología de Villa Clara (CENTOX-VC), e identificar los tipos de plantas causales, lugar de procedencia del paciente intoxicado y tipo de intoxicación más frecuente. Métodos: se realizó un estudio observacional, descriptivo, retrospectivo en el Centro de Toxicología Clínica de Villa Clara, Cuba, durante los cuatro primeros años de su creación (2008-2011), considerando variables como edad, municipio y/o provincia, planta tóxica responsable, causas de la intoxicación y vías de exposición. Resultados: se atendieron 70 pacientes intoxicados en la consulta de urgencia por plantas tóxicas (8,22 por ciento). Hubo mayor incidencia en el año 2009 con 47 pacientes (67,1 por ciento). Predominó el rango de edad entre 5 y 14 años, el sexo masculino (57,1 por ciento); las intoxicaciones más frecuentes fueron por nuez o nogal (Aleurites trilobus J.R. Forst. & G. Forst) (52,9 por ciento), piñón de botija (Jatropha curcas L) (14,3 por ciento), salvadera (Hura crepitans L) y yuquilla (Cycas circinalis L) (12,9 por ciento) y (10 por ciento) respectivamente. Predominaron las intoxicaciones no intencionales (94,3 por ciento) y la vía de exposición digestiva (95,8 por ciento). Cifuentes fue el municipio de mayor incidencia con 37 pacientes...

Introduction: accidental or intentional exposure to toxic substances is a frequent cause of poisoning worldwide. Statistical reports show a predominance of poisoning by psycholeptics and pesticides, but poisoning by toxic plants is also frequently treated at emergency services. Objective: characterize the incidence and morbidity of acute poisoning by toxic plants as reported by Villa Clara Toxicology Center (CENTOX-VC) and identify the types of causal plants, place of residence of the poisoned patient and most frequent poisoning type. Methods: an observational retrospective descriptive study was conducted at Villa Clara Clinical Toxicology Center in Cuba during the four years following the founding of the Center (2008-2011). The variables considered were age, municipality and/or province, causal toxic plant, causes of the poisoning episode and manner of exposure. Results: seventy patients were cared for at the emergency service for poisoning by toxic plants (8.22 percent). The highest incidence was found in the year 2009 with 47 patients (67.1 percent). There was a predominance of the 5-14 age range and the male sex (57.1 percent). The most frequent causal agents were walnut tree (Aleurites trilobus J. R. Forst. & G. Forst) (52.9 percent), physic nut (Jatropha curcas L.) (14.3 percent), sandbox tree (Hura crepitans L.) (12.9 percent) and queen sago (Cycas circinalis L.) (10 percent). A predominance was observed of unintentional poisoning (94.3 percent) and oral intake (95.8 percent). The highest incidence was found in the municipality of Cifuentes with 37 patients (52.8 percent). Conclusions: a characterization is provided of poisoning by toxic plants which includes reference to...

[Case of law-evading herbs poisoning that induced shock and myocardial damage].

Law-evading herbs may induce poisoning symptoms, especially when they contain synthetic cannabinoids. However, their detailed pharmacological effects have not yet been clarified. Some reports have previously described symptoms of poisoning, but only a few reports have so far described shock and myocardial damage (MD). We experienced a case of shock and MD in a patient who had smoked law-evading herbs. A 61-year-old male presented at an emergency department 8 hours after smoking law-evading herbs (Rush Trip, High Men Monster) with chest pain. A vasopressor agent was administered to treat shock and antiarrhythmic drugs were administered due to ventricular arrhythmia. The contents of the law-evading herbs were unknown, so an in-hospital follow-up was conducted to treat the patient's symptoms. The follow-up blood test showed an increased level of cardiac enzymes, which thereafter demonstrated a spontaneous remission. The systemic conditions tended to improve and the patient was discharged from the hospital on the 5th hospital day. The contents of the law-evading herbs in question were thereafter,analyzed, and synthetic cannabinoids (JWH-210, JWH-081 and JWH-122) as well as caffeine were detected. The cause for the poisoning symptoms were suspected to be the presence of synthetic cannabinoids and caffeine. Such law-evading herbs may contain synthetic cannabinoids and caffeine which both may induce shock and MD.

Colchicine poisoning: a case report and review of literature.

Colchicine, a natural pseudo-alkaloid found in plants such as the Colchicum autumnale and Gloriosa superba has tremendous medicinal properties, but if misused by an unqualified person can result in fatal consequences. We report a case of colchicine poisoning in an adult man as a result of consumption of the herb G. superba by a 50-year-old man and review the literature.

Upper urinary tract urothelial cancers: where it is A:T.

Despite a ban on the use of plants of the Aristolochia genus in herbal medicine, as they contain known carcinogens, urothelial carcinoma attributable to the use of this plant seems to be more common than previously thought.

Accidental poisoning after ingestion of "aphrodisiac" berries: diagnosis by analytical toxicology.

BACKGROUND: A large number of plants, seeds, and berries have been used for medicinal, psychotropic, or aphrodisiac purposes for a thousand years. Mandragora officinarum belongs to the family of Solanaceae and is traditionally known as an aphrodisiac and is closely associated with witchcraft. OBJECTIVES: In this study we report a case of an accidental poisoning after ingestion of some "aphrodisiac" berries and the contribution of the toxicological analysis in the case investigation. CASE REPORT: A 35-year-old man was admitted to the hospital with clinical signs and symptoms of an anticholinergic syndrome. The diagnosis of the poisoning was made by the toxicological analysis of the patient's urine. The cause of the poisoning was revealed by his girlfriend's disclosure that the patient had intentionally consumed some "aphrodisiac" berries to enhance his sexual performance. Subsequently, berries similar to the ones consumed were sent to the laboratory. The analysis of the urine and the berries revealed the presence of hyoscyamine and scopolamine; the berries were identified as Mandragora officinarum berries. Decontamination and symptomatic treatment were proven effective for the control of this poisoning. The patient recovered completely after hospitalization for 4 days. CONCLUSION: This case report indicates the importance of analytical toxicology in diagnosis of intoxications after the consumption of unknown plants or plant products and presents the clinical aspects of Mandragora intoxication.

[Accidental intoxication with eucalyptus oil--a case report]. / Przypadkowe zatrucie olejem eukaliptusowym--opis przypadku.

Eucalyptus oil (EO) intoxications are rare. We present a case of 58 yrs old chemist, who due to intense delusions consumed 4-5 drops of concentrated EO in order to self-medication of ascariasis. Despite the low dose of ingested xenobiotic the course of poisoning was severe. The intoxication was complicated with acute lung and heart injury, tachycardia and hypertension. Most of the clinical symptoms and biochemical abnormalities disappeared after the treatment.

A review of the potential forensic significance of traditional herbal medicines.

Traditional herbal substances may contain highly toxic chemicals and heavy metals, in addition to naturally occurring organic toxins. These substances may cause illness, exacerbate pre-existing ill health or result in death, particularly if taken in excess or in an unusual manner (e.g., injected rather than ingested). Lack of regulation of the content and quality of herbal medicines may result in contamination and adulteration with prescription medications. As there may be no history of the specific use of these products their contribution to death may not be fully appreciated during a standard autopsy. Even when their existence is known or suspected, it may be difficult to identify these substances on standard toxicologic screening. Herbal medicines may also be responsible for a range of symptoms and signs that may confuse the clinical presentation of cases. Given these issues the role of herbal medicines in forensic practice needs to be more clearly defined as deaths may be occurring where herbal medicines have made a significant, but as-yet unrecognized, contribution.