CalotropisCalotropis

Calotropis / Giant Milkweed:Calotropis / Giant Milkweed:

Common nameCommon name: : عشيرعشير Scientific nameScientific name: : Calotropis proceraCalotropis procera

(Ait.) Ait. fil.(Ait.) Ait. fil. FamilyFamily: Asclepiadaceae : Asclepiadaceae

Toxic ingredientToxic ingredient:: The plant contains active The plant contains active cardiac glycosidescardiac glycosides . . The latex contains a no. of cardioactive The latex contains a no. of cardioactive

glycosides, calactin, calotropin, calotoxin, glycosides, calactin, calotropin, calotoxin, uscharin, uscharidine, voruscharin, tannins, uscharin, uscharidine, voruscharin, tannins, flavonoids, sterols and /or triterpenes.flavonoids, sterols and /or triterpenes.

The leaves and stalks contain calotropin, The leaves and stalks contain calotropin, calotropagenin.calotropagenin.

A new norditerpenyl ester, named A new norditerpenyl ester, named Calotropterpenyl ester, and two pentacyclic Calotropterpenyl ester, and two pentacyclic triterpenoids, namely calotropursenyl acetate and triterpenoids, namely calotropursenyl acetate and

calotropfriedelenyl acetate have been isolated calotropfriedelenyl acetate have been isolated from the root bark of from the root bark of Calotropis procera.Calotropis procera.

The glycoside calotropin is extremely potent.The glycoside calotropin is extremely potent.

Toxic parts:Toxic parts: Latex: can be strong irritant to skin Latex: can be strong irritant to skin

and mucous membranes, it exhibits and mucous membranes, it exhibits inflammation and iridocyclitis, inflammation and iridocyclitis, cardiotoxicity, liver damage, cardiotoxicity, liver damage, testicular necrosis testicular necrosis

NicotianaNicotiana

Nicotiana:Nicotiana: Common nameCommon name: : تمباك تمباك شجرة دخان دخان , , شجرة

Scientific nameScientific name: : Nicotiana Nicotianaشجريشجريglaucaglauca R.C. Graham R.C. Graham

Nicotiana rustica Nicotiana rustica (L.)(L.) Nicotiana tabacumNicotiana tabacum (L.) (L.) FamilyFamily: Solanaceae : Solanaceae

N. tabacumN. tabacum: : NicotineNicotine is the major toxic alkaloid is the major toxic alkaloid with a concentration in leaves ranging from 1.5%-with a concentration in leaves ranging from 1.5%-4% by dry weight 2.4% by dry weight 2.

N. glaucaN. glauca: : Anabasine Anabasine and nicotine are the and nicotine are the dominant alkaloids, fruits and leaves are richest dominant alkaloids, fruits and leaves are richest in anabasine ( leaf contains 1.3% by weight) 2, in anabasine ( leaf contains 1.3% by weight) 2, followed by roots, flowers and stems 3.followed by roots, flowers and stems 3.

Nicotine is the water-soluble alkaloid ((S)-3-(1-Nicotine is the water-soluble alkaloid ((S)-3-(1-methyl-2-pyrrolidinyl) pyridine) and has an methyl-2-pyrrolidinyl) pyridine) and has an alkaline pKa of 8.5; it belongs to the alkaline pKa of 8.5; it belongs to the pyridine/piperidine alkaloids.pyridine/piperidine alkaloids.

Anabasine (1-(3-pyridyl) piperidine) is Anabasine (1-(3-pyridyl) piperidine) is pharmacologically similar to nicotine.pharmacologically similar to nicotine.

NicotineNicotine

AnabasineAnabasine

Toxic partsToxic parts: Leaves.: Leaves. Toxic doseToxic dose:: Nicotine is highly toxic, 2-5 mg may cause Nicotine is highly toxic, 2-5 mg may cause

nausea, 40-60 mg may be lethal 4.nausea, 40-60 mg may be lethal 4. Nicotine is well absorbed from the skin, Nicotine is well absorbed from the skin,

lungs and gastrointestinal tract, it appears lungs and gastrointestinal tract, it appears to be poorly absorbed in the acidic pH of to be poorly absorbed in the acidic pH of the stomach 2.the stomach 2.

Cases of intoxication by ingesting the Cases of intoxication by ingesting the plant are infrequent, they can occur as the plant are infrequent, they can occur as the result of an error, or deliberate ingestion result of an error, or deliberate ingestion which leaded to death due to consumption which leaded to death due to consumption of of N. glaucaN. glauca leaves leaves

Mechanism of action:Mechanism of action: Nicotine exerts its effects by binding Nicotine exerts its effects by binding

to a subset of cholinergic receptors, to a subset of cholinergic receptors, the nicotinic receptors, which are the nicotinic receptors, which are located in ganglia at the located in ganglia at the neuromuscular junction, and also neuromuscular junction, and also within the central nervous system, within the central nervous system, where the psychoactive and where the psychoactive and addictive properties reside 7.addictive properties reside 7.

Initially, and only briefly, nicotine is stimulating to Initially, and only briefly, nicotine is stimulating to the autonomic nervous system ganglia and the autonomic nervous system ganglia and neuromuscular junction. The most prominent neuromuscular junction. The most prominent effects relate to stimulation of the adrenal effects relate to stimulation of the adrenal medulla, central nervous system, cardiovascular medulla, central nervous system, cardiovascular system (release of catecholamines), system (release of catecholamines), gastrointestinal tract (parasympathetic gastrointestinal tract (parasympathetic stimulation), salivary and bronchial glands and stimulation), salivary and bronchial glands and the medullary vomiting center.the medullary vomiting center.

There is subsequent blockade of autonomic There is subsequent blockade of autonomic ganglia and the neuromuscular junction ganglia and the neuromuscular junction transmission, inhibition of catecholamine release transmission, inhibition of catecholamine release from the adrenal medulla, and central nervous from the adrenal medulla, and central nervous system depression.system depression.

ManifestationsManifestations:: ▫ ▫ Nicotine is an extremely lethal poison.Nicotine is an extremely lethal poison. ▫ ▫ Symptoms of nicotine poisoning may develop Symptoms of nicotine poisoning may develop

within 15 min., the onset of symptoms much within 15 min., the onset of symptoms much more rapid after ingestion of liquid nicotine (e.g. more rapid after ingestion of liquid nicotine (e.g. insecticides) compared with nicotine –contained insecticides) compared with nicotine –contained in organic material (plant parts).in organic material (plant parts).

▪ ▪ The onset of symptoms begins with The onset of symptoms begins with gastrointestinal distress (vomiting, nausea, gastrointestinal distress (vomiting, nausea, salivation, abdominal pain, and diarrhea) .salivation, abdominal pain, and diarrhea) .

▪ ▪ CNS: headache, confusion, dizziness, ataxia, CNS: headache, confusion, dizziness, ataxia, agitation, restlessness and incoordination develop agitation, restlessness and incoordination develop initially after serious nicotine overdose.initially after serious nicotine overdose.

Later, in severe poisoning, convulsions and coma Later, in severe poisoning, convulsions and coma may occur.may occur.

Respiratory system: Initial Respiratory system: Initial tachypnea, but late dyspnea, tachypnea, but late dyspnea, decreased respiratory rate and decreased respiratory rate and cyanosis may be seen.cyanosis may be seen.

Respiratory arrest may occur and Respiratory arrest may occur and results into death.results into death.

▪ ▪ Cardiovascular system: A transient Cardiovascular system: A transient increase in blood pressure followed increase in blood pressure followed by hypotension, bradycardia, by hypotension, bradycardia, paroxysmal atrial fibrillation or paroxysmal atrial fibrillation or cardiac standstill is observed.cardiac standstill is observed.

● ● Green tobacco sickness:Green tobacco sickness: It is an occupational disorder that affects It is an occupational disorder that affects

specifically the workers who harvest tobacco.specifically the workers who harvest tobacco. It is characterized by weakness, dizziness, It is characterized by weakness, dizziness,

headache, lightheadedness, abdominal pain, headache, lightheadedness, abdominal pain, nausea, vomiting and in many cases respiratory nausea, vomiting and in many cases respiratory difficulties.difficulties.

The manifestations are associated with the The manifestations are associated with the transdermal absorption of nicotine.transdermal absorption of nicotine.

The disease is self-limited and resolves by the The disease is self-limited and resolves by the following day.following day.

There is high incidence of the occurrence of the There is high incidence of the occurrence of the disease when the tobacco leaves, the skin or both disease when the tobacco leaves, the skin or both are damp (dew, rain, sweat).are damp (dew, rain, sweat).

Wearing gloves and protective clothing is Wearing gloves and protective clothing is recommended 8.recommended 8.

POTATOPOTATO

Potato:Potato: Common nameCommon name: : بطاطابطاطا Scientific name: Scientific name: Solanum Solanum

tuberosumtuberosum Family: Family: Solanaceae.Solanaceae.

Glycoalkaloid Glycoalkaloid solanine.solanine. Solanine designates a mixture of six compounds, three Solanine designates a mixture of six compounds, three

solanines and three chaconines.solanines and three chaconines. The aglycone common to all of the alkaloids is solanidine The aglycone common to all of the alkaloids is solanidine Solanidine is structurally similar to steroids; its proposed Solanidine is structurally similar to steroids; its proposed

biosynthetic pathway is from acetate through cholesterol.biosynthetic pathway is from acetate through cholesterol. α- solanine and α- chaconine represent 90%-95% of the α- solanine and α- chaconine represent 90%-95% of the

alkaloids occurring in the plant.alkaloids occurring in the plant. Solanine is water-soluble and is removed by boiling but not Solanine is water-soluble and is removed by boiling but not

baking.baking. It is poorly absorbed from the gastrointestinal tract.It is poorly absorbed from the gastrointestinal tract. Elimination occurs rapidly in the feces and to lesser extent Elimination occurs rapidly in the feces and to lesser extent

in urine. It concentrates in tissues in the following order: in urine. It concentrates in tissues in the following order: spleen, kidney, liver, lung, fat, heart, brain, blood spleen, kidney, liver, lung, fat, heart, brain, blood

Toxic parts:Toxic parts: Ripe fruit contains the least amount of Ripe fruit contains the least amount of

solanine, which appears in a nontoxic solanine, which appears in a nontoxic amount.amount.

Human poisoning occurs after Human poisoning occurs after consumption of green or stressed consumption of green or stressed potatoes.potatoes.

The toxic alkaloids are produced by the The toxic alkaloids are produced by the periderm, the cortex and areas of high periderm, the cortex and areas of high metabolic activity such as the eyes and metabolic activity such as the eyes and sprouts, green skin and stems sprouts, green skin and stems

Exposure:Exposure: Solanine poisoning is rare except in Solanine poisoning is rare except in

times of food shortages.times of food shortages. Although most solanine is removed Although most solanine is removed

by peeling and boiling, a few by peeling and boiling, a few outbreaks occurred as a result of outbreaks occurred as a result of catering errors or unusual conditions catering errors or unusual conditions

Factors that increase solanine Factors that increase solanine concentration:concentration:

Although solanine exists throughout the Although solanine exists throughout the plant, its concentration varies over a wide plant, its concentration varies over a wide range because of a host of environmental range because of a host of environmental and genetic factors.and genetic factors.

Studies revealed that the following factors Studies revealed that the following factors increase alkaloid concentration:increase alkaloid concentration:

1. Storage in lighted areas: exposure to 1. Storage in lighted areas: exposure to sunlight for 6 hours multiplies the sunlight for 6 hours multiplies the concentration of solanine by four (from 5 concentration of solanine by four (from 5 to 20 mg/100g), after 72 hours of to 20 mg/100g), after 72 hours of exposure to sunlight, the concentration exposure to sunlight, the concentration can reach 45mg/100g 1,2,3.can reach 45mg/100g 1,2,3.

2. Species variation.2. Species variation.

3. Physiological stress.3. Physiological stress.

4. mmaturity (i.e. green potatoes).4. mmaturity (i.e. green potatoes).

5. Storage conditions: potatoes are 5. Storage conditions: potatoes are well kept in dark between 9-15 ◦C well kept in dark between 9-15 ◦C and in a dry atmosphere.and in a dry atmosphere.

6. Trauma: any minor damage (cuts or 6. Trauma: any minor damage (cuts or crushing) leads to a 200%-300% crushing) leads to a 200%-300% increase in the solanine increase in the solanine concentration.concentration.

Toxic dose in humans is estimated to Toxic dose in humans is estimated to be between 2-5 mg/kg of solanine.be between 2-5 mg/kg of solanine.

LD50 in humans was found to be 75 LD50 in humans was found to be 75 mg/kg via IP route.mg/kg via IP route.

Manifestations:Manifestations: Gastrointestinal and neurologic symptoms Gastrointestinal and neurologic symptoms

predominate in cases of solanine predominate in cases of solanine poisoning depending on the amount poisoning depending on the amount ingested.ingested.

Vomiting, diarrhea, anorexia, malaise, Vomiting, diarrhea, anorexia, malaise, headache and flushing are the most headache and flushing are the most common symptoms.common symptoms.

Non-gastrointestinal-- symptoms may Non-gastrointestinal-- symptoms may include fever, altered mental status include fever, altered mental status (drowsiness, confusion, delirium), (drowsiness, confusion, delirium), restlessness and hallucinations.restlessness and hallucinations.

Some patients may have hypotension, Some patients may have hypotension, tachycardia and stupor.tachycardia and stupor.

Nonspecific symptoms and visual blurring Nonspecific symptoms and visual blurring may develop.may develop.

Allergic symptoms of immediate urticaria Allergic symptoms of immediate urticaria and angioedema related to contact with and angioedema related to contact with raw potato was described. A prick-by-prick raw potato was described. A prick-by-prick test with potato pulp and rub test were test with potato pulp and rub test were positive. Specific IgE to potato was positive. Specific IgE to potato was positive 5. The major potato allergen is positive 5. The major potato allergen is patatin, Sol t 16.patatin, Sol t 16.

Deaths have been associated with Deaths have been associated with consumption of toxic potatoes, but these consumption of toxic potatoes, but these reports involved malnourished patients reports involved malnourished patients who may not have received adequate who may not have received adequate care.care.

Treatment :Treatment : ▪ ▪ Gut decontamination (syrup of ipecac/ Gut decontamination (syrup of ipecac/

lavage, charcoal, cathartics) may be useful lavage, charcoal, cathartics) may be useful for those patients who are seen early (4 for those patients who are seen early (4 hours) and who don’t have spontaneous hours) and who don’t have spontaneous vomiting and diarrhea.vomiting and diarrhea.

▪ ▪ General supportive care: fluid status General supportive care: fluid status should be evaluated in every patient by should be evaluated in every patient by means of orthostatic pulse and blood means of orthostatic pulse and blood pressure. Electrolytes should be checked pressure. Electrolytes should be checked on those patients who exhibit profound on those patients who exhibit profound changes or who take medications that changes or who take medications that alter the fluid or electrolyte balance.alter the fluid or electrolyte balance.

An intravenous line should be established An intravenous line should be established on those patients who exhibit orthostatic on those patients who exhibit orthostatic hypotension or neurologic signs.hypotension or neurologic signs.

Seriously ill patients who don’t respond to Seriously ill patients who don’t respond to fluid replacement, may need cardiac fluid replacement, may need cardiac monitoring and vasopressors.monitoring and vasopressors.

Seizures are treated by diazepam.Seizures are treated by diazepam. Patients with neurologic signs or Patients with neurologic signs or

orthostatic changes should be admitted for orthostatic changes should be admitted for at least 24 hours of observations.at least 24 hours of observations.