Beware of Neurotoxins in Common Plants: Water Hemlock Poisoning Presenting as Convulsive Status Epilepticus.

BACKGROUND: Pediatric status epilepticus occurs in about 44/100.000 children per year with an unknown cause in about a third of patients. One cause can be the ingestion of plants containing toxins that target the central nervous system. Here we describe an ingestion of water hemlock resulting in a status epilepticus. METHODS: We studied in detail the clinical, laboratory, electrophysiological, and radiological features of a patient with status epilepticus. RESULTS: A 9-year-old boy presented to the pediatric emergency department for sudden onset of nausea, vomiting, and status epilepticus approximately one hour after the patient had bitten into the root of a water plant in an inner-city park. Bilateral tonic-clonic seizures could only be terminated after administration of midazolam, lorazepam, and finally propofol. Cranial MRI, cerebrospinal fluid, and EEG findings were largely unremarkable. The ingested plant was identified as water hemlock through a detailed search with the help of a drawing issued by the patient with the help of the medical team. The specific toxicological analysis for water hemlock verified the presence of cicutoxin and cicudiol in the blood sample. The patient was discharged, levetiracetam was weaned off four weeks later, and he has remained seizure free since. CONCLUSIONS: Given the considerable percentage of cases of unknown etiology in new-onset pediatric status epilepticus, it is important to consider plant intoxication as a possible cause.

Evaluation of diazepam as a drug treatment for water hemlock (Cicuta species) poisoning in Spanish goats.

Water hemlocks (Cicuta spp.) are toxic members of the Apiaceae plant family. The best drug treatment for the convulsions associated with acute water hemlock poisoning in livestock and humans has not been determined experimentally. This work compared the therapeutic actions of benzodiazepines (diazepam) and barbiturates (phenobarbital) on water hemlock poisoning in a goat model. C. maculata tubers were orally dosed to goats. Experimental groups consisted of; control saline; 20 mg/kg phenobarbital; 1.0 mg/kg diazepam; 10 mg/kg diazepam; and 1.0 mg/kg diazepam administered as needed to moderate convulsions by intravenous (i.v.) infusion. Diazepam provided nearly instant control of convulsions. Clinical signs of poisoning were completely controlled for the duration of the experiment in the goats that received the 10 mg/kg diazepam dose. These results suggest that diazepam is effective at managing the clinical signs of water hemlock poisoning in goats. We speculate that diazepam can be used as a potential treatment for water hemlock poisoning in other livestock species and humans.

Efficacy of Cicuta virosa medicinal preparations against pentylenetetrazole-induced seizures.

Epileptic seizures are characterized by imbalanced inhibition-excitation cycle that triggers biochemical alterations responsible for jeopardized neuronal integrity. Conventional antiepileptic drugs (AEDs) have been the mainstay option for treatment and control; however, symptomatic control and potential to exacerbate the seizure condition calls for viable alternative to these chemical agents. In this context, natural product-based therapies have accrued great interest in recent years due to competent disease management potential and lower associated adversities. Cicuta virosa (CV) is one such herbal remedy that is used in traditional system of medicine against myriad of disorders including epilepsy. Homeopathic medicinal preparations (HMPs) of CV were assessed for their efficacy in pentylenetetrazole (PTZ)-induced acute and kindling models of epilepsy. CV HMPs increased the latency and reduced the duration of tonic-clonic phase in acute model while lowering the kindling score in the kindling model that signified their role in modulating GABAergic neurotransmission and potassium conductance. Kindling-induced impairment of cognition, memory, and motor coordination was ameliorated by the CV HMPs that substantiated their efficacy in imparting sustained neuronal fortification. Furthermore, biochemical evaluation showed attenuated oxidative stress load through reduced lipid peroxidation and strengthened free radical scavenging mechanism. Taken together, CV HMPs exhibited promising results in acute and kindling models and must be further assessed through molecular and epigenomic studies.

Three poisonous plants (Oenanthe, Cicuta and Anamirta) that antagonise the effect of γ-aminobutyric acid in human brain.

Although we are familiar with common British plants that are poisonous, such as Atropa belladonna (deadly nightshade) and Aconitum napellus (monkshood), the two most poisonous plants in the British Flora are Oenanthe crocata (dead man's fingers) and Cicuta virosa (cowbane). In recent years their poisons have been shown to be polyacetylenes (n-C2H2). The plants closely resemble two of the most common plants in the family Apiaceae (Umbelliferae), celery and parsley. Unwittingly, they are ingested by naive foragers and death occurs very rapidly. The third plant Anamirta derives from South-East Asia and contains a powerful convulsant, picrotoxin, which has been used from time immemorial to catch fish, and more recently to poison Birds of Paradise. All three poisons have been shown to block the γ-aminobutyric acid (GABA) system in the human brain that normally has a powerful inhibitory neuronal action. It has also been established that two groups of sedative drugs, barbiturates and benzodiazepines, exert their inhibitory action by stimulating the GABA system. These drugs are the treatments of choice for poisoning by the three vicious plants.

The acute toxicity of water hemlock (Cicuta douglasii) in a goat model.

Water hemlock (Cicuta douglasii) is one of the most toxic plants to livestock and humans. Little is known regarding the amount of plant required to cause death. The objective of this study was to determine a lethal dose of water hemlock in a goat model. Plants were dosed to goats via oral gavage of freeze-dried ground plant material. The results from this study suggest that 1-2 fresh tubers would be lethal to goats.

The non-competitive blockade of GABAA receptors by an aqueous extract of water hemlock (Cicuta douglasii) tubers.

Water hemlocks (Cicuta spp.) are acutely toxic members of the Umbellierae family; the toxicity is due to the presence of C17-polyacetylenes such as cicutoxin. There is only limited evidence of noncompetitive antagonism by C17-polyacetylenes at GABAA receptors. In this work with WSS-1 cells, we documented the noncompetitive blockade of GABAA receptors by an aqueous extract of water hemlock (Cicuta douglasii) and modulated the actions of the extract with a pretreatment of 10 µM midazolam.

Insect spontaneous ultraweak photon emission as an indicator of insecticidal compounds.

The influence of beta-cypermethrin, a commercial insecticide, and Cicuta virosa L. var. latisecta Celak (Umbelliferae:Cicutal), an insecticidal plant, on the spontaneous ultraweak photon emissions from larvae of Spodoptera litura Fabricius and Zophobas morio Fabricius were studied. The increased percentages of spontaneous photon emission intensities from S. litura treated with 0.1 and 1 µg/ml beta-cypermethrin were both lower than those of the control in the 24 post-treatment hours, remarkable difference could also be observed during the same period from Z. morio treated with beta-cypermethrin at 0.156, 0.313 and 0.625 µg/ml. The increased percentages of spontaneous photon emission intensities from the two mentioned insects treated with 10,100 and 1000 µg/ml petroleum ether fraction of C. virosa L. var. latisecta, which displayed little activity against whole insects, could also be changed noticeably. The present study indicated that change in the intensity of spontaneous ultraweak photon emission from insect could be used as a novel method for screening insecticidal compounds with very low content in plant.

Chemical composition and antifungal activity of essential oil from Cicuta virosa L. var. latisecta Celak.

The essential oil extracted from the fruits of Cicuta virosa L. var. latisecta Celak was tested in vitro and in vivo against four foodborne fungi, Aspergillus flavus, Aspergillus oryzae, Aspergillus niger, and Alternaria alternata. Forty-five different components accounting for 98.4% of the total oil composition were identified by gas chromatography-mass spectrometry. The major components were γ-terpinene (40.92%), p-cymene (27.93%), and cumin aldehyde (21.20%). Antifungal activity was tested by the poisoned food technique against the four fungi. Minimum inhibitory concentration against the fungi was 5 µL/mL and percentage inhibition of mycelial growth was determined at day 9. The essential oil had a strong inhibitory effect on spore production and germination in all tested fungi proportional to concentration. The oil exhibited noticeable inhibition on dry mycelium weight and synthesis of aflatoxin B1 (AFB1) by A. flavus, completely inhibiting AFB(1) production at 4 µL/mL. The effect of the essential oil on inhibition of decay development in cherry tomatoes was tested in vivo by exposing inoculated and control fruit to essential oil vapor at a concentration of 200 µL/mL. Results indicated that the essential oil from C. virosa var. latisecta (CVEO) has potential as a preservative to control food spoilage.

Tratamento homeopático emergencial por traumatismo em Aratinga leucophthalma (Statius Muller, 1776): relato de caso / Homeopathic treatment in emergency trauma in Aratinga leucophthalma (Statius Muller, 1776): case report

O número crescente de aves de estimação tem aumentado o número de atendimentos nas clínicas de pequenos animais. O estudo particular da medicina avíaria se torna necessário para um melhor atendimento do paciente, em especial as emergências, haja vista que, na maioria das vezes a consulta de emergência é a primeira consulta de uma ave. O presente estudo descreve o tratamento homeopático emergencial de uma ave de estimação por trauma e a terapia suporte. discute-se também o tratamento homeopático em casos de emergência. O tratamento homeopático mostrou-se eficaz na emergência, o que permitiu o retorno das atividades normais da ave em período curto de tempo.

Tratamento homeopático emergencial por traumatismo em Aratinga leucophthalma (Statius Muller, 1776): relato de caso / Homeopathic treatment in emergency trauma in Aratinga leucophthalma (Statius Muller, 1776): case report

O número crescente de aves de estimação tem aumentado o número de atendimentos nas clínicas de pequenos animais. O estudo particular da medicina avíaria se torna necessário para um melhor atendimento do paciente, em especial as emergências, haja vista que, na maioria das vezes a consulta de emergência é a primeira consulta de uma ave. O presente estudo descreve o tratamento homeopático emergencial de uma ave de estimação por trauma e a terapia suporte. discute-se também o tratamento homeopático em casos de emergência. O tratamento homeopático mostrou-se eficaz na emergência, o que permitiu o retorno das atividades normais da ave em período curto de tempo.(AU)

Seed longevity and germination characteristics of six fen plant species.

Fens are among the most threatened habitats in Europe as their area has decreased considerably in the last centuries. For successful management and restoration conservationists need detailed knowledge about seed bank formation and seed longevity of plants, as these features are closely related to successional and vegetation dynamical processes. I analysed seed longevity and the germination characteristics of six fen plant species by seed burial experiments. Based on seed weight, seed bank was expected for long-term persistent for the light-seeded Schoenus nigricans, Carex appropinquata, C. pseudocyperus, C. davalliana and Peucedanum palustre and also that for the medium-seeded Cicuta virosa. It was proved that, the latter two species have short-term persistent seed banks, while Carex pseudocyperus has a transient seed bank, therefore these species may only have a limited role in restoration from seed banks. It was found that Schoenus nigricans, Carex appropinquata and C. davalliana have persistent seed banks, because some of their four-year-old seeds have emerged. Fresh seeds had low germination rate in all studied species and majority of seeds emerged after winter, except for Carex pseudocyperus. After the germination peak in spring, the majority of the ungerminated seeds of Schoenus nigricans, Peucedanum palustre, Carex appropinquata, C. davalliana and Cicuta virosa entered a secondary dormancy phase that was broken in autumn. I found the seasonal emergence of the latter three species highly similar.

[Study on chemical constituents from Cicuta virosa var. latisecta].

OBJECTIVE: To investigate the chemical constituents in Cicuta virosa var. latisecta. METHOD: Many kinds of column chromatography were used to isolate the compounds from the EtOH ext. of C. virosa var. latisecta. The chemical constituents of the plant were identified by means of IR, MS, 1H-NMR, 13C-NMR, respectively, in some case by direct comparison with authentic samples. RESULT: Nine compounds were isolated from the aerial part and were identified as: 3beta-acetyloxy-16-hydroxy-olean-12-en-28-oic acid (1), 9 (11), 12-dieneoleana-3beta-ol (2), 9, 19-cyclolanaost-24-en-3-one (3), 9, 19-cycloergost-23-en-3, 25-diol (4), stigmasterol (5), falcarindiol (6), 1, 2-benzenedicarboxylic acid, his (2-ethylhexyl) ester (7), stigmast-5-en-3beta-ol (8), beta-daucosterol (9). CONCLUSION: Compound 1 is a new natural product, and compounds 2 to 9 were firstly isolated from this plant.

Poisoning due to water hemlock.

INTRODUCTION: Water hemlock, which encompasses a range of species divided across two genera (Cicuta and Oenanthe), are regarded as being among the most poisonous plants both in North America and in the United Kingdom. Despite their toxicity, the literature consists almost entirely of case reports. AIM: The aim of this review is to summarize this literature by covering all aspects of taxonomy and botanical characterization, principal toxins, basic pharmacology including mechanisms of toxicity, and the clinical features, diagnosis, and management of poisoning. MECHANISMS OF TOXICITY: The principal toxins, cicutoxin and oenanthotoxin, belong to a group of C17 conjugated polyacetylenes. They act as (noncompetitive) gamma-aminobutyric acid antagonists in the central nervous system (CNS), resulting in unabated neuronal depolarization that can lead to seizures. Ingestion of even a small amount of plant matter may result in severe intoxication. FEATURES: After ingestion, the patient is most likely to experience CNS stimulatory effects including seizures that, in the absence of aggressive supportive care, can result in death. Other features include nausea, vomiting, diarrhea, tachycardia, mydriasis, rhabdomyolysis, renal failure, coma, respiratory impairment, and cardiac dysrhythmias. MANAGEMENT: Treatment consists mainly of prompt airway management and seizure control, plus decontamination if achieved early and after stabilization. In the event of renal failure, the use of hemodialysis has been employed successfully. CONCLUSIONS: The ingestion of water hemlock can lead to serious complications that may be fatal. Prognosis is good, however, if prompt supportive care is provided.

Study on chemical constituents from Cicuta virosa var. latisecta / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the chemical constituents in Cicuta virosa var. latisecta.</p><p><b>METHOD</b>Many kinds of column chromatography were used to isolate the compounds from the EtOH ext. of C. virosa var. latisecta. The chemical constituents of the plant were identified by means of IR, MS, 1H-NMR, 13C-NMR, respectively, in some case by direct comparison with authentic samples.</p><p><b>RESULT</b>Nine compounds were isolated from the aerial part and were identified as: 3beta-acetyloxy-16-hydroxy-olean-12-en-28-oic acid (1), 9 (11), 12-dieneoleana-3beta-ol (2), 9, 19-cyclolanaost-24-en-3-one (3), 9, 19-cycloergost-23-en-3, 25-diol (4), stigmasterol (5), falcarindiol (6), 1, 2-benzenedicarboxylic acid, his (2-ethylhexyl) ester (7), stigmast-5-en-3beta-ol (8), beta-daucosterol (9).</p><p><b>CONCLUSION</b>Compound 1 is a new natural product, and compounds 2 to 9 were firstly isolated from this plant.</p>

Relato de caso clínico: tratamento homeopático em paciente com infecções urinárias de repetição

O estudo foi feito a partir da escolha de caso clínico, em que foram usados os medicamentos: Cicuta virosa e Natrum muriaticum,. Estes medicamentos foram usados neste caso de síndrome medular (Paraparesia Espástica Tropical – PET) que interessa particularmente à Neurologia. A paciente apresentava cistites de repetição há 10 anos, conseqüente a um quadro de mielite infecciosa viral que compromete a função vesical e a homeostase das vias urinárias de forma geral. Como há resíduo, a paciente é cateterizada duas vezes ao dia, e esta interferência, juntamente com a disfunção da bexiga, tem causado cistites freqüentes.Descrevemos o caso da paciente, sua evolução, escolha do medicamento e as medidas tomadas em cada consulta, evidenciando a melhoria da qualidade de vida no tratamento homeopático.(AU)

Plant exposures: wilderness medicine.

This article discusses poisonous plants, the symptoms that might arise if they are ingested, and the treatments that should be administered to patients.

Síntese dos ácidos montipóricos A e B, virol C e ácido pinélico / Montiporic acids A and B, Virol C and pinellic acid

Esta tese descreve, em três diferentes capítulos, a preparação de quatro produtos naturais com atividade biológica reconhecida. O primeiro se refere à síntese de dois ácidos carboxílicos diacetilênicos, os ácidos montipóricos A e B, isolados dos ovos do coral duro Montipora digitata e que apresentam atividade citotóxica e antibacteriana. Estas sínteses foram alcançadas utilizando-se reações de acoplamento de acetilenos e eterificação por CTF. Reações de transposição de ligação tripla e redução de acetileno terminal por semi-hidrogenação com Lindlar/`H IND. 2', ou hidroteluração/transmetalação Te-Li, são discutidas. O segundo capítulo descreve a síntese do virol C, um diol poliacetilênico análogo à cicutoxina, isolado como um dos componentes tóxicos da planta Cicuta virosa...