eMedicine Specialties > Emergency Medicine > Toxicology

Plant Poisoning, Caladium, Dieffenbachia, and Philodendron: Follow-up

Author: Jennifer S Boyle, MD, PharmD, Fellow in Toxicology, University of Virginia Health System
Coauthor(s): Christopher P Holstege, MD, Associate Professor of Emergency Medicine and Pediatrics, University of Virginia; Director, Division of Medical Toxicology, Center of Clinical Toxicology; Medical Director, Blue Ridge Poison Ctr, Associate Medical Toxicology Fellowship Director, VA Dept of Health
Contributor Information and Disclosures

Updated: Dec 9, 2008

Follow-up

Further Inpatient Care

  • Inpatient care is rarely necessary in patients with toxic exposure to Caladium, Dieffenbachia, or Philodendron.

Further Outpatient Care

  • Analgesia is the mainstay of treatment, and usually, over-the-counter acetaminophen or ibuprofen can be used. Codeine derivatives occasionally may be necessary.
  • Maintain adequate hydration with clear cool fluids.
  • Instruct patients to avoid salty or spicy foods, which may worsen the pain.

Inpatient & Outpatient Medications

  • Acetaminophen
  • Ibuprofen
  • Codeine, hydrocodone, or oxycodone

Transfer

  • Transfer is rarely necessary, except in patients with severe swelling with airway compromise.

Deterrence/Prevention

  • Because 70% of exposures occur in children younger than 5 years, mostly within the home, prevention is paramount.
  • All poisonous and injurious plants must be kept away from children.
  • Parents of small children should keep potentially toxic household plants out of reach of children, just as they do with medications and cleaning supplies. The simplest and most effective way of safeguarding children is to avoid keeping toxic plants in and around the home.
  • Children should be specifically instructed never to eat plants or wild berries.

Complications

  • No long-term complications have been reported.

Prognosis

  • Although painful, effects are self-limited.
  • Prognosis is excellent.

Patient Education

  • Instruct parents or guardians to accurately identify all ornamental plants and foliage around the home and to remove all potentially toxic plants.
  • Instruct children to never eat plants or wild berries.

Miscellaneous

Medicolegal Pitfalls

  • Failure to identify the correct exposure(s)
  • Failure to provide adequate decontamination
  • Failure to provide adequate analgesia
  • Failure to provide adequate instructions that detail the early warning signs of excessive drooling or stridor
  • Failure to provide adequate follow-up for ocular exposures

Special Concerns

  • Provide adequate analgesia so that the patient can take oral fluids and maintain hydration.
 


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References
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References

  1. Bronstein AC, Spyker DA, Cantilena LR Jr, Green J, Rumack BH, Heard SE. 2006 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS). Clin Toxicol (Phila). Dec 2007;45(8):815-917. [Medline].

  2. Snajdauf J, Mixa V, Rygl M, Vyhnanek M, Moravek J, Kabelka Z. Aortoesophageal fistula--an unusual complication of esophagitis caused by Dieffenbachia ingestion. J Pediatr Surg. Jun 2005;40(6):e29-31. [Medline].

  3. Arditti J, Rodriguez E. Dieffenbachia: uses, abuses and toxic constituents: a review. J Ethnopharmacol. May 1982;5(3):293-302. [Medline].

  4. Cumpston KL, Vogel SN, Leikin JB, Erickson TB. Acute airway compromise after brief exposure to a Dieffenbachia plant. J Emerg Med. Nov 2003;25(4):391-7. [Medline].

  5. Evans CR. Oral ulceration after contact with the houseplant Dieffenbachia. Br Dent J. Jun 20 1987;162(12):467-8. [Medline].

  6. Gardner DG. Injury to the oral mucous membranes caused by the common houseplant, dieffenbachia. A review. Oral Surg Oral Med Oral Pathol. Nov 1994;78(5):631-3. [Medline].

  7. Krenzelok EP, Jacobsen TD. Plant exposures ... a national profile of the most common plant genera. Vet Hum Toxicol. Aug 1997;39(4):248-9. [Medline].

  8. Kuballa B, Lugnier AA, Anton R. Study of Dieffenbachia-induced edma in mouse and rat hindpaw: respective role of oxalate needles an trypsin-like protease. Toxicol Appl Pharmacol. May 1981;58(3):444-51. [Medline].

  9. Lawrence RA. Poisonous plants: when they are a threat to children. Pediatr Rev. May 1997;18(5):162-8. [Medline].

  10. Mrvos R, Dean BS, Krenzelok EP. Philodendron/dieffenbachia ingestions: are they a problem?. J Toxicol Clin Toxicol. 1991;29(4):485-91. [Medline].

  11. Pedaci L, Krenzelok EP, Jacobsen TD, Aronis J. Dieffenbachia species exposures: an evidence-based assessment of symptom presentation. Vet Hum Toxicol. Oct 1999;41(5):335-8. [Medline].

  12. Rao SK, Kumar SK, Biswas J, Fogla R, Gopal L, Padmanabhan P. Self-induced corneal crystals: a case report. Cornea. May 2000;19(3):410-1. [Medline].

  13. Rauber A. Observations on the idioblasts of Dieffenbachia. J Toxicol Clin Toxicol. 1985;23(2-3):79-90. [Medline].

  14. Sanchez-Morillas L. Contact dermatitis due to Dieffenbachia. Contact Dermatitis. Sep 2005;53(3):172-3. [Medline].

  15. Seet B, Chan WK, Ang CL. Crystalline keratopathy from Dieffenbachia plant sap. Br J Ophthalmol. Jan 1995;79(1):98-9. [Medline].

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Further Reading

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Keywords

Caladium, Dieffenbachia, Philodendron, dumb cane, dumbcane, elephant's ears, plant poisoning, toxic plants, contact dermatitis, keratoconjunctivitis, aortoesophageal fistula, respiratory compromise

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Contributor Information and Disclosures

Author

Jennifer S Boyle, MD, PharmD, Fellow in Toxicology, University of Virginia Health System
Disclosure: Nothing to disclose.

Coauthor(s)

Christopher P Holstege, MD, Associate Professor of Emergency Medicine and Pediatrics, University of Virginia; Director, Division of Medical Toxicology, Center of Clinical Toxicology; Medical Director, Blue Ridge Poison Ctr, Associate Medical Toxicology Fellowship Director, VA Dept of Health
Christopher P Holstege, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American Association for the Advancement of Science, American College of Emergency Physicians, American College of Medical Toxicology, American Medical Association, Medical Society of Virginia, Society for Academic Emergency Medicine, Society of Toxicology, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Michael E Mullins, MD, Assistant Professor, Department of Emergency Medicine, Washington University School of Medicine
Michael E Mullins, MD is a member of the following medical societies: American Academy of Clinical Toxicology and American College of Emergency Physicians
Disclosure: Johnson & Johnson stock ownership None; Savient Pharmaceuticals stock ownership None

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Jeffrey R Tucker, MD, Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center
Jeffrey R Tucker, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Pediatrics, and Massachusetts Medical Society
Disclosure: Merck Salary Employment

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Timothy E Corden, MD, Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin
Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society
Disclosure: Nothing to disclose.

 
 
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