Plant Poisoning: Elephant's Ear Ingestion

Elephant's Ear (DDT) 1

Plant Poisoning: Plant Poisoning: Elephant’s Ear IngestionElephant’s Ear Ingestion

Dexter TagwireyiDexter Tagwireyi, , BPharm(Hons), GradDipTox, MAppSc(Tox), PhDBPharm(Hons), GradDipTox, MAppSc(Tox), PhD

Drug & Toxicology Information ServiceDrug & Toxicology Information ServiceDepartment of PharmacyDepartment of PharmacyUniversity of ZimbabweUniversity of Zimbabwe

By the End of this Talk…

• Delegates must be able to describe the clinical toxicology of exposure to Elephant’s Ear plant

• Delegates must be able to identify few other toxic plants and have an idea of their toxicology

• Delegates must have learnt something



IntroductionIntroduction

• Ingestion of plants by kids (esp. toddlers) Ingestion of plants by kids (esp. toddlers) common worldwidecommon worldwide

• inquisitive kidsinquisitive kids• ‘‘experimentation’experimentation’• hungerhunger• otherother

• Number of plants potentially toxic - but exposure Number of plants potentially toxic - but exposure appears more common with certain species:appears more common with certain species:

• Araceae Araceae Family most common cause of symptomatic plant Family most common cause of symptomatic plant exposure in Zimbabwe and elsewhere exposure in Zimbabwe and elsewhere


Elephant’s Ear Plant Elephant’s Ear Plant • These are beautiful ornamental plants:These are beautiful ornamental plants:

– normally have large elephant shaped leavesnormally have large elephant shaped leaves– normally green leaves, but may be other coloursnormally green leaves, but may be other colours

• A number of plant species are referred to as A number of plant species are referred to as Elephant’s Ear, but normally:Elephant’s Ear, but normally:– Colocasia Colocasia and and Alocasia Alocasia spp.spp.

• Tubers are used as food in other communitiesTubers are used as food in other communities• Related to Related to Diffenbachia Diffenbachia - including the - including the

toxicology toxicology


ToxicologyToxicology

• All parts of the plant are toxic on exposureAll parts of the plant are toxic on exposure• Plants contain calcium oxalate crystals which are Plants contain calcium oxalate crystals which are

needle-shaped in compact bundles (raphides)needle-shaped in compact bundles (raphides)

• Chewing leads to expulsion of calcium oxalate Chewing leads to expulsion of calcium oxalate crystals - lodge into mouth, tongue, throatcrystals - lodge into mouth, tongue, throat

On ChewingCalcium oxalate crystal are ejected


ToxicologyToxicology• The crystals lead to inflammation of the oral The crystals lead to inflammation of the oral

cavity including the throat and severe paincavity including the throat and severe pain• Calcium oxalate is not readily absorbed Calcium oxalate is not readily absorbed

because it is ionisedbecause it is ionised• In large doses, the hydrochloric acid in the In large doses, the hydrochloric acid in the

GIT reacts with calcium oxalate to form GIT reacts with calcium oxalate to form oxalic acid - freely absorbedoxalic acid - freely absorbed

• On absorption, oxalic acid leads to On absorption, oxalic acid leads to systematic effects of poisoningsystematic effects of poisoning


• Oxalic acid binds to calcium (Ca++) ions in Oxalic acid binds to calcium (Ca++) ions in the blood --- reduction of Ca++ ions --- this the blood --- reduction of Ca++ ions --- this results in muscular and cardiac problemsresults in muscular and cardiac problems

• In kidneys, Ca++ binds to oxalic acid resulting In kidneys, Ca++ binds to oxalic acid resulting in the formation of calcium oxalate crystals - - in the formation of calcium oxalate crystals - - formation of stones - - nephrotoxicity and formation of stones - - nephrotoxicity and other renal problemsother renal problems

• Local inflammation as a result ofLocal inflammation as a result of• direct effect of calcium oxalate on buccal liningdirect effect of calcium oxalate on buccal lining• ‘‘breaking’ of mast cellsbreaking’ of mast cells• proteolytic enzymes on grooves of crystalsproteolytic enzymes on grooves of crystals• bradykinin-like substancesbradykinin-like substances


Toxic DoseToxic Dose

• Normally one bite is enough to ‘discourage’ Normally one bite is enough to ‘discourage’ further mastication of the plantfurther mastication of the plant

• systemic effects rare, but have been systemic effects rare, but have been documented with the ingestion of larger documented with the ingestion of larger quantities e.g., quantities e.g., – the whole leafthe whole leaf– one documented case for Zimbabwe (Tagwireyi one documented case for Zimbabwe (Tagwireyi

& Ball, 2002)& Ball, 2002)


Clinical PresentationClinical Presentation

Local EffectsLocal Effects• Pain in the mouth with inflammationPain in the mouth with inflammation• Swelling of buccal mucosaSwelling of buccal mucosa• Dysphagia, burning sensationDysphagia, burning sensation• DysphoniaDysphonia• Swelling of pharynx (cause of death in Swelling of pharynx (cause of death in

experimental animals)experimental animals)


Systematic Signs and SymptomsSystematic Signs and Symptoms• these occur mainly as a result of a decrease these occur mainly as a result of a decrease

in Ca++ ions in the body fluids and include:in Ca++ ions in the body fluids and include:– muscular spasms and crampsmuscular spasms and cramps– bradycardiabradycardia– hypotensionhypotension– arrhythmia'sarrhythmia's– respiratory failure and bradypnoearespiratory failure and bradypnoea– renal insufficiency (nephrotoxicity)renal insufficiency (nephrotoxicity)


ManagementManagement

• ABCs - if obstruction presentABCs - if obstruction present• endotracheal intubation/tracheostomyendotracheal intubation/tracheostomy

• For local symptomsFor local symptoms• rinse mouth with cold waterrinse mouth with cold water• demulcent e.g., cold water, ice creamdemulcent e.g., cold water, ice cream• simple analgesics e.g., paracetamolsimple analgesics e.g., paracetamol• antacids may be usedantacids may be used• ““the benefit of corticosteroids and/or antihistamines the benefit of corticosteroids and/or antihistamines

remains questionable - don’t use themremains questionable - don’t use them


• For systemic symptomatologyFor systemic symptomatology– calcium gluconate and chloride may be given to calcium gluconate and chloride may be given to

replenish calcium ion storesreplenish calcium ion stores– give fluids to dissolve calcium oxalate crystals give fluids to dissolve calcium oxalate crystals

in the renal system as well as to prevent further in the renal system as well as to prevent further crystalluriacrystalluria

– give other supportive therapy as deemed give other supportive therapy as deemed necessary according to the symptommatologynecessary according to the symptommatology

MonitorMonitor• Airway, renal system and the Airway, renal system and the

cardiovascular systemcardiovascular system

References

• Tagwireyi D, Ball DE (2001). Management of Elephant’s Ear Poisoning. Human & Experimental Toxicology 20 (4) pp 189 - 192



May God Bless You All!!!May God Bless You All!!!


Other Common Toxic Other Common Toxic PlantsPlants

Nerium Oleander


Nerium Oleander – White Flowers


Thevetia peruviana


Highlights• Toxic components cardiac glycosides

– Oleandrin, oleandroside and others (Thevetin A and B for Thevetia peruviana

– Flowers pose hazard in accidental poisoning, but all parts toxic

• Symptoms– Nausea, vomiting, abdominal cramps and bloody

diarrhoea– Confusion, dizziness, drowsiness, visual disturbances– Ventricular disarrythmias, tachyarrythmias,

bradycardia, heart block


Ricinus Communis


Highlights

• Toxicity due to ricin– Lethal dose reported to be 4 – 8 seeds but rare

• Symptoms of overdose (2-4hrs…may be delayed)– Nausea, diarrhoea, abdominal pains– Tachycardia, hypotension– Seizures up to a week– Beleeding disorders


Abrus Precatorius


Highlights

• Toxicity as a result of abrin– Ingestion of a single seed could kill an adult??

• Toxicity similar to ricin


Jatropha curcas


Highlights

• Seeds contain curcin and carcinogenic phorbol

• Symptoms– Mainly GIT, emesis, nausea, vomiting,

diarrhoea– Blood clotting disorders


Datura stramonium


Boophone disticha


Gloriosa superba


By the End of this Talk…

• Delegates must be able to describe the clinical toxicology of exposure to Elephant’s Ear plant

• Delegates must be able to identify few other toxic plants and have an idea of their toxicology

• Delegates must have learnt something


Also

• Raw tomatoes and leaves• Raw potatos and leaves• Pips of apples, plum seeds• Cassava• Other


Plant Poisoning: Elephant's Ear Ingestion

Health & Medicine

Transcript of Plant Poisoning: Elephant's Ear Ingestion