Highlights & Basics
- Common toxic plant ingestion may be intentional (consumption/smoking of concentrated extracts) or accidental.
- Severe or life-threatening clinical consequences are rare.
- The most lethal plants are the most uncommon and rarely reported exposures: water hemlock, jimson weed seeds, castor bean, rosary pea, monkshood, autumn crocus, and oleander.
- There may be physiologic effects in the gastrointestinal, cardiac, neurologic, pulmonary, dermatologic, and hematologic systems.
- Unusual plant ingestions may cause intractable seizures, acidosis, liver necrosis, heart block, hypotension, tachycardia, or hypertension.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Citations
Froberg B, Ibrahim D, Furbee RB. Plant poisoning. Emerg Med Clin North Am. 2007 May;25(2):375-433.[Abstract]
Gummin DD, Mowry JB, Beuhler MC, et al. 2022 Annual report of the National Poison Data System(®) (NPDS) from America's Poison Centers(®): 40th annual report. Clin Toxicol (Phila). 2023 Oct;61(10):717-939.[Abstract][Full Text]
Halpern JH. Hallucinogens and dissociative agents naturally growing in the United States. Pharmacol Ther. 2004 May;102(2):131-8.[Abstract]
Gowdy JM. Stramonium intoxication: review of symptomatology in 212 cases. JAMA. 1972 Aug 7;221(6):585-7.[Abstract]
Burkhard PR, Burkhardt K, Haenggeli CA, et al. Plant-induced seizures: reappearance of an old problem. J Neurol. 1999 Aug;246(8):667-70.[Abstract]
1. Froberg B, Ibrahim D, Furbee RB. Plant poisoning. Emerg Med Clin North Am. 2007 May;25(2):375-433.[Abstract]
2. Gummin DD, Mowry JB, Beuhler MC, et al. 2022 Annual report of the National Poison Data System(®) (NPDS) from America's Poison Centers(®): 40th annual report. Clin Toxicol (Phila). 2023 Oct;61(10):717-939.[Abstract][Full Text]
3. Krenzelok EP, Mrvos R. Friends and foes in the plant world: a profile of plant ingestions and fatalities. Clin Toxicol (Phila). 2011 Mar;49(3):142-9.[Abstract]
4. Rodrigues TD, Johnson PN, Jeffrey LP. Holly berry ingestion: case report. Vet Hum Toxicol. 1984 Apr;26(2):157-8.[Abstract]
5. Hall AH, Spoerke DG, Rumack BH. Assessing mistletoe toxicity. Ann Emerg Med. 1986 Nov;15(11):1320-3.[Abstract]
6. Salgado N, Silva MA, Figueira ME, et al. Oxalate in foods: extraction conditions, analytical methods, occurrence, and health implications. Foods. 2023 Aug 25;12(17):3201.[Abstract][Full Text]
7. Gummin DD, Mowry JB, Beuhler MC, et al. 2021 Annual report of the National Poison Data System(©) (NPDS) from America's Poison Centers: 39th annual report. Clin Toxicol (Phila). 2022 Dec;60(12):1381-643.[Abstract][Full Text]
8. Bah M, Bye R, Pereda-Miranda R. Hepatotoxic pyrrolizidine alkaloids in the Mexican medicinal plant Packera candidissima (Asteraceae: Senecioneae). J Ethnopharmacol. 1994 Jun;43(1):19-30.[Abstract]
9. Griffin DS, Segall HJ. Genotoxicity and cytotoxicity of selected pyrrolizidine alkaloids, a possible alkenal metabolite of the alkaloids and related alkenals. Toxicol Appl Pharmacol. 1986 Nov;86(2):227-34.[Abstract]
10. McGee D, Brabson T, McCarthy J, et al. Four-year review of cigarette ingestions in children. Pediatr Emerg Care. 1995 Feb;11(1):13-6.[Abstract]
11. Dasgupta A, Hart AP. Rapid detection of oleander poisoning using fluorescence polarization immunoassay for digitoxin: effect of treatment with digoxin-specific Fab antibody fragment (ovine). Am J Clin Pathol. 1997 Oct;108(4):411-6.[Abstract]
12. Chan TY. Aconite poisoning. Clin Toxicol (Phila). 2009 Apr;47(4):279-85.[Abstract]
13. Pierog J, Kane B, Kane K, et al. Management of isolated yew berry toxicity with sodium bicarbonate: a case report in treatment efficacy. J Med Toxicol. 2009 Jun;5(2):84-9.[Abstract]
14. Halpern JH. Hallucinogens and dissociative agents naturally growing in the United States. Pharmacol Ther. 2004 May;102(2):131-8.[Abstract]
15. Payne RB. Nutmeg intoxication. N Engl J Med. 1963 Jul 4;269:36-9.[Abstract]
16. Zhou Z, Wu L, Zhong Y, et al. Gelsemium elegans poisoning: a case with 8 months of follow-up and review of the literature. Front Neurol. 2017;8:204.[Abstract][Full Text]
17. Sukmandari NS, Dash GK, Jusof WHW, et al. A review on Nephelium lappaceum L. Research J Pharm and Tech. 2017;10(8):2819-27.[Full Text]
18. Boumba VA, Mitselou A, Vougiouklakis T. Fatal poisoning from ingestion of Datura stramonium seeds. Vet Hum Toxicol. 2004 Apr;46(2):81-2.[Abstract]
19. Gowdy JM. Stramonium intoxication: review of symptomatology in 212 cases. JAMA. 1972 Aug 7;221(6):585-7.[Abstract]
20. Burkhard PR, Burkhardt K, Haenggeli CA, et al. Plant-induced seizures: reappearance of an old problem. J Neurol. 1999 Aug;246(8):667-70.[Abstract]
21. Krenzelok EP, Jacobsen TD, Aronis JM. Hemlock ingestions: the most deadly plant exposures (abstract). J Toxicol Clin Toxicol. 1996;34:601-2.
22. Oliver F, Amon EU, Breathnach A, et al. Contact urticaria due to the common stinging nettle (Urtica dioica): histological, ultrastructural and pharmacological studies. Clin Exp Dermatol. 1991 Jan;16(1):1-7.[Abstract]
23. Hilman BC, Kurzweg FT, McCook WW Jr, et al. Foreign body aspiration of grass inflorescences as a cause of hemoptysis. Chest. 1980 Aug;78(2):306-9.[Abstract][Full Text]
24. Hogan RP 3rd. Hemorrhagic diathesis caused by drinking an herbal tea. JAMA. 1983 May 20;249(19):2679-80.[Abstract]
25. Palatnick W, Tenenbein M. Hepatotoxicity from castor bean ingestion in a child. J Toxicol Clin Toxicol. 2000;38(1):67-9.[Abstract]
26. Deahl M. Betel nut-induced extrapyramidal syndrome: an unusual drug interaction. Mov Disord. 1989;4(4):330-2.[Abstract]
27. Vetter J. Plant cyanogenic glycosides. Toxicon. 2000 Jan;38(1):11-36.[Abstract]
28. Abbes M, Montana M, Curti C, et al. Ricin poisoning: a review on contamination source, diagnosis, treatment, prevention and reporting of ricin poisoning. Toxicon. 2021 May;195:86-92.[Abstract]
29. Ghorani-Azam A, Sepahi S, Riahi-Zanjani B, et al. Plant toxins and acute medicinal plant poisoning in children: a systematic literature review. J Res Med Sci. 2018 Mar 27;23:26.[Abstract][Full Text]
30. Schep LJ, Slaughter RJ, Beasley DM. Nicotinic plant poisoning. Clin Toxicol (Phila). 2009 Sep;47(8):771-81.[Abstract]
31. Shrivastava A, Kumar A, Thomas JD, et al. Association of acute toxic encephalopathy with litchi consumption in an outbreak in Muzaffarpur, India, 2014: a case-control study. Lancet Glob Health. 2017 Apr;5(4):e458-66.[Abstract][Full Text]
32. Weinberg RB. Hunan hand. N Engl J Med. 1981 Oct 22;305(17):1020.[Abstract]
33. Roberge R, Brader E, Martin ML, et al. The root of evil: pokeweed intoxication. Ann Emerg Med. 1986;15:470-473.[Abstract]
34. Burns MJ, Linden CH, Graudins A, et al. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med. 2000 Apr;35(4):374-81.[Abstract]
35. Wagstaff DJ, Raisbeck M, Wagstaff AT. Poisonous plant information system (PPIS). Vet Hum Toxicol. 1989 Jun;31(3):237-8.[Abstract]
36. U.S Food and Drug Administration. Temporary importation of anticholium ® (physostigmine salicylate) ampules with foreign, non-U.S. labeling to address supply shortage. Sep 2023 [internet publication].[Full Text]
37. U.S. Food and Drug Administration. Temporary importation available for physostigmine injection. Oct 2023 [internet publication].[Full Text]
38. Borys DJ, Setzer SC, Hornfeldt CS. A retrospective review of plant exposures as reported to the Hennepin Regional Poison Center in 1985. Vet Hum Toxicol. 1987 Feb;29(1):83-5.[Abstract]
39. Stegelmeier BL, Edgar JA, Colegate SM, et al. Pyrrolizidine alkaloid plants, metabolism and toxicity. J Nat Toxins. 1999 Feb;8(1):95-116.[Abstract]
40. Safadi R, Levy I, Amitai Y, et al. Beneficial effect of digoxin-specific Fab antibody fragments in oleander intoxication. Arch Intern Med. 1995 Oct 23;155(19):2121-5.[Abstract]
41. Adaniya H, Hayami H, Hiraoka M, et al. Effects of magnesium on polymorphic ventricular tachycardias induced by aconitine. J Cardiovasc Pharmacol. 1994 Nov;24(5):721-9.[Abstract]
42. Sawanobori T, Adaniya H, Hirano Y, et al. Effects of antiarrhythmic agents and Mg2+ on aconitine-induced arrhythmias. Jpn Heart J. 1996 Sep;37(5):709-18.[Abstract]
43. Kolev ST, Leman P, Kite GC, et al. Toxicity following accidental ingestion of Aconitum containing Chinese remedy. Hum Exp Toxicol. 1996 Oct;15(10):839-42.[Abstract]
44. Clara A, Rauch S, Überbacher CA, et al. High-dose magnesium sulfate in the treatment of aconite poisoning [in German]. Anaesthesist. 2015 May;64(5):381-4.[Abstract]
45. Holbrook A, Schulman S, Witt DM, et al; American College of Chest Physicians. Evidence-based management of anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(2 suppl):e152S-e184S.[Abstract][Full Text]
46. Watkins JW, Schwarz ES, Arroyo-Plasencia AM, et al. The use of physostigmine by toxicologists in anticholinergic toxicity. J Med Toxicol. 2015 Jun;11(2):179-84.[Abstract][Full Text]
47. Moore PW, Rasimas JJ, Donovan JW. Physostigmine is the antidote for anticholinergic syndrome. J Med Toxicol. 2015 Mar;11(1):159-60.[Abstract][Full Text]
48. 43rd International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT), 23-26 May 2023, Palma de Mallorca, Spain. Clin Toxicol. 2023;61(suppl 1):1-129.[Full Text]
49. Roberts DM, Buckley NA. Antidotes for acute cardenolide (cardiac glycoside) poisoning. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD005490.[Abstract][Full Text]
50. Sriapha C, Tongpoo A, Wongvisavakorn S, et al. Plant poisoning in Thailand: a 10-year analysis from Ramathibodi poison center. Southeast Asian J Trop Med Public Health. 2015 Nov;46(6):1063-76.[Abstract]
