Plant poisoning

Dr. Ravi Nanayakkara

 Objectives
• Introduction, classification and identification of
poisonous plants.
• Circumstances, route of entry, metabolism and
excretion of plant poisons.
• Mechanism of action, target organs, clinical
features(early and late phase) and principles of
management.
• Autopsy features(external and internal) and
sample collection.
 Plant poisoning

 More than 300 poisonous plants.

 Some are edible.

 Act on more than one organ, but act

principally on one organ system.
Classification
• Neurotoxins
• Cardiac toxins
• Gastrointestinal irritants
• Cellular poisons
Neurotoxins
• Datura stramonium
• Substances of abuse
Canabis sativa
Erythrocylon coca
Papaver somniferum
• Strychnos Nux vomika
Cardiac toxins
• Nerium odorum

• Thevetia peruviana
Gastro intestinal irritants

• Gloria superba

• Ricinus communis
Cellular poisons

• Manihot utilissma

• Adenia palmeta
 Datura stramonium
• Attana
• CNS
 Toxic substances

 Atropine
 Hyoscine
 Hyocyamine
 Scopolamine

All are alkaloids

 Circumstances

 Accidental –Children eat the seed or fruit

Eating the leaves (mistakenly)
 Intentional – for revenge, confuse an enemy
to robbery – mix with thalaguli
during long distance bus travels
 Suicidal ingestion rare.
 Absorption
• GIT

• Skin

• Mucous membranes
 Target Organs - Atropine
• brain, heart, smooth muscles, glands

• Excretion - Kidney
 Clinical features
• Shown in the table.
Organs Pathophysiology Clinical Features

CNS Stimulation Followed by depression Euphoria, delirium aggression,

terrifying hallucinations,
bizarre behaviour, confusion,
convulsions,
increased muscle tone,
Unconsciousness

Heart Parasympathetic block — > stimulation Tachycardia, hypertension,

Tachyarrythmias rarely

Skin Inhibition of sweat glands, Dilatation of blood Dry, hot Flushes

vessels

Eyes Relaxation of radial muscles of Mydriasis and blurring of vision,

pupils, Inhibition of lachrymal photophobia, Dry eyes
glands

Alimentary tract Inhibition of salivary glands ,Inhibition of Dry mouth,

intestinal musculature leading to Reduced gut motility
relaxation
 Principles of Management
• Eliminate the poison

• Phytostigmine to reverse the action

• Diazepam to control fits

• Manage complications accordingly

 Mode of death
• Respiratory paralysis  Asphyxia
 Postmortem finding
• Non specific
• Seeds or fragments of the plant may be found
in the stomach.stomach may show slight
inflmmation.
• Lungs : pulmonary oedema.
• Other organs will show sings of asphyxia.
 Specimen collection
• Stomach and contents

• Intestine

• Urine

• Blood
 Canabis sativa
• Ganja – flower

• Marijuana – flowery tops / cut leaves

• Hashish – dried resin

• H oil – oily extract

 Toxic substances
• Alkaloids
• Cannabinol
• Cannabidiol
• Cannabidiolic acid
 Circumstances
• Smoking

• Beverage

• With datura
 Clinical features
• Inhibitions removed – like alcohol
• Confusion
• Restlessness
• Hallucinations
• Narcosis
• Nausea
• Depression
 Principles of management
• Symptomatic
 Autopsy
• Non specific
• Features of addiction
 Erythrocylon coca
• Grows in Central/South America
• Toxic Substances
• Alkaloid – cocaine
• Leaves
• Synthetic
• Action – stimulates CNS and CVS
similarly to adrenalin
 Clinical features

Shown in the table.

Pathophysiology Clinical features

CNS - Initial stimulation Excitement, hallucinations, euphoria,

hyperkinesis, headache, nausea, vomiting,
Late - depression twitching of small facial muscles, stereotype
behaviour, hypereflexia, tonic-clonic seizures
Hyporeflexia, coma, respiratory and
cardiovascular depression

CVS - Initial stimulation – Tachycardia, hypertension, ventricular

dysrhythmias Weak, slow pulse; low blood
Late – depression pressure

Respiratory system - Initial stimulation – Late Tachypnoea, slow shallow breathing,

depression cyanosis
Vasoconstriction, Hyperactivity (psycho-motor) pallor, hyperthermia
Pyrogenic action on thermoregulatory centre

Sympathomimetic action on intestinal wall Diarrhoea, abdominal cramps

Constriction of radial muscles of the pupil Dilatation of pupil
Discussed in drugs of abuse
 Papaver somniferum
(Opium / Heroin)
• Unriped capsule of poppy plant

• Alkaloids – morphine
codeine
narcolin
papavarin ……
 Circumstances
• Ingestion

• Inhalation

• Injections
 Clinical features
• Excitement – euphoria

• Depression of brain stem

• Narcosis and death

Discussed in drugs of abuse
 Strychnos Nux vomika
Goda/Divi kaduru
• Spinal stimulant
• Commonly found in Southern costal area.
• Toxin is mainly found in seeds.
• Poison – Strychnine ( an alkaloid)
Circumstances
• Accidental – Children eat fruit
• Suicidal rare due to bitter
• Homicidal rare due to bitter
• Extract of seeds(strychnine) is used to as a
rodenticide, kill stray dogs by injecting with a
long stick
• Homicidal injection - rare
Absorption
• All mucosal surfaces
• Rapidly absorbed via GIT and spread
throughout body
Target organ
• Spinal cord and brain
Action
• Strychnine stimulate the brain and spinal cord
by inhibiting the inhibitory pathways.
• Hyperexcitation of brain stem and spinal cord.
• Slightest stimulation can cause convulsions.
Clinical features
• Bitter taste in mouth
• Muscle stiffness
• Tremors
• Twitching
• Convulsions
• Concious till death
 Differential diagnosis
• Tetanus
Read
Management
• Maintain airway, breathing, circulation
• Control fits
• Minimum stimulation
Gastric lavarge and vomiting can
precipitate convulsion.
• Management of complications
Mode of death
• Hypoxia to brain stem

Respiratory paralysis

Asphyxia
Autopsy
• Non specific
• Asphyxia
• Muscle haemorrhages
 Cardio vascular system
• Thevetia peruviana – Yellow oliander
• Nerium oleander – Pink oliander
Nerium oleander
Thevetia peruviana
Circumstances
• Suicide-consume fruits

• Accidental – any part of the plant (children)

• Homicidal-rare
Toxic substance
• Cardiac glycosides – digitalis like action
• Inhibit Na+/K+ ATPase
• Alteration of membrane potential in
myocardium and neurones
• Increse cardiac
Excitability
Contractility
Automaticity
 Route of absorption
• GIT-injestion
 Target organs
• Heart (mainly) - Arrhythmias

• CNS - Neuronal excitability  depression

• GIT-irritant
 Clinical features
• Faintishness,papitation,
irregular pulse,hypotensoin
• Yellow vision,blurred vision,dilated pupils,
muscular twiching,tetanic spasms,anxiety,
confusion
• Nausea,vomiting
• Pain in throat and numbness in tongue and
lips,abdominal pain,profuse salivation
 Principles of management
• Emesis
• Activated charcoal
• Antidote-Kaneru tab
(Antibody against cardiac glycosides)
• Management of complications
 Mode of death

• Circulatory failure

• Arrhythmias

Lethal dose : 8-10 seeds, 15-20g root

 Autopsy

• Non specific

• GIT irritation

• Fragments of seed in stomach

Cerbera manghus(Diya kaduru)
• Poisonous part – Fruit seeds

• Poison - Cardiogenic glycosides

 
• Circumstances - Accidental, suicidal

• Clinical features - Cardiac arrhythmias

 
Gloriosa superba (Niyangala)
• Main suicidal poison before availability of
pesticides
• Grows throughout the island
Toxic substances
• Colchicine- Cellular poison
• Choline
• Salicylic acid
Mode of action
• Colchicine-cellular poison

Mitosis arrested.

Cell death.
• Choline – action same as acetyl choline
• Salicylic acid – Local irritant
 Circumstances

• Accidental-yams

• Suicidal

• Homicidal
 Target organs
• Gastro intestinal tract

• Bone marrow

• CNS

• Smooth muscles
 Clinical features
• Shown in the table.
Patho – physiology Symptoms and signs Time of onset after ingestion

Acute inflammation of alimentary burning pain, numbness, itching within 6- 12 hrs

tract mucosa due to local actions of and tingling around mouth and
salicylic acid and benzoic acid throat. Nausea, vomiting,
dehydration, thirst, blood and
mucus diarrhoea

Augmentation by choline of abdominal colic, ileus, tenesmus, within 6- 12 hrs

autonomic contraction of smooth breathlessness
muscles throughout the body. In abortion
gastrointestinal tract , bronchi ,
uterus

Block of mitosis, by cholchicine in bleeding gums, easy bruising within 6 hrs

bone marrow→
bone marrow aplasia→
Throinbocytopenia

Acute tubular necrosis of the kidney decreased urine output,

haematuria

Central nervous system stimulation, Restlessness, confusion, after 36 hrs

then depression. delirium, convulsions, coma
Respiratory centre depression Breathlessness

Arrest of cell division in hair follicles Alopecia, generalized depilation after 1-2 weeks
Rapid shedding of stratum corneum
 Principles of management

• Gastric lavage

• Activated charcoal

• Management of complications
 Autopsy

• Features of acute dehydration and GI irriration

• Features of complication
Ricinus communis(Endaru)
• Entire plant is poisonous
• Seeds most poisonous
• Grows throughout the island
• Absorption
GI mucosa
Mode of action
Ricin

Blockage of protein synthesis

Cell death

Tissue necrosis

Acute inflammation
 Circumstances

• Accidental –Children

• Suicidal

• Homicidal-rare
 Clinical features
Pathology Clinical features
Alimentary tract Burning, sensation of mouth, throat, chest,
Acute inflammation abdomen, salivation, nausea, vomiting
diarrhoea
↙ ↘
Dehydration electrolyte
(thirst) imbalance
↓ ↓
shock muscle cramps
(oliguria) (abdomen/calves)
drowsiness, delirium, convulsions
Haemorrhagic gastroenteritis, erosions abdominal pain,haematemesis,bloody diarrhoea

Kidney haematuria. albuminuria. oliguria. uraemia

Nephritis,
Acute renal tailure

Liver jaundice
Necrosis. Inflammation

Circulation
 Management
• Gastric lavarge
• Complication
 Mode of death

• Circulatory failure

• Renal failure

• Respiratory failure
 Autopsy

• GIT irritation

• Seeds in stomach

• Non specific (Oedema and foci of necrosis)

Specimen
• Gastric contents
• Blood
• Histology
Liver
Kidney
Stomach and intestine
Manihot utilisma

• Cyanogenic glycoside
 Clinical features
• Nausea
• Vomiting
• Abdominal pain
• Diarrhoea
• Respiratory failure
 Management

• Complications
Autopsy
• Contents in stomach
• Non specific
 Poisoning ?
• National Poisons Information Centre
National Hospital of Sri Lanka Colombo.

0112686143, 0112691111 Ext 430

 Summary
• CNS
• GIT
• CVS
• Cellular toxic
 Plants
• Datura stramonium
• Canabies sativum
• Erythrocylon cocca
• Papova somniferum
• Strichnus nux vomica
• Nerium odorum
• Gloriosa superba
• Ricinus communis
 For each plant
• Toxic substance
• Circumstances
• Absorption
• Actions / target organs
• Clinical features
• Management
• Modes of death
• Post mortem findings
• Samples
Thank You.