eMedicine Specialties > Emergency Medicine > Toxicology

Plant Poisoning, Caladium, Dieffenbachia, and Philodendron

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

Introduction

Background

According to the 2006 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System, 2,403,539 human exposures were reported, of which 64,236 (2.7%) were exposures to plants.¹ Children younger than 5 years were responsible for 44,710 of those plant exposures.¹ The plant species most frequently reported in human exposures were Spathiphyllum, Euphorbia pulcherrima, and Ilex. Philodendron and Caladium species were also listed among the most commonly reported plant exposures. Philodendron and Dieffenbachia species (also called dumb cane) are commonly found in homes, offices, and waiting rooms.

Pathophysiology

Philodendron, Dieffenbachia, and Caladium contain calcium oxalate crystals packaged into bundles called raphides. However, the presence of calcium oxalate crystals alone is not enough to cause the toxicity seen with exposure to these plants. Although the exact mechanism of toxicity remains unclear, the presence of proteolytic enzymes, in addition to specialized cells that forcibly expel the raphides, seems to be necessary to inflict injury.

Frequency

United States

In 2006, data collected by the American Association of Poison Control Centers indicated that plants were the 16th most commonly reported substance involved in human toxic exposures.¹ Children younger than 5 years were responsible for most of these exposures.

Mortality/Morbidity

Patients with history of oral exposure (chewing and/or swallowing) have been reported to have severe swelling, drooling, dysphagia, and respiratory compromise, but this is not common. In a large retrospective study of 188 patients with plant oxalate exposure, all cases were determined to be minor and all resolved with minor or no treatment. Patients can also experience dermal and ocular exposure, resulting in contact dermatitis or keratoconjunctivitis. Symptoms that result from these routes of exposure also appear to resolve with supportive care. The serious complication of aortoesophageal fistula following ingestion of a dieffenbachia leaf in a girl aged 12.5 years has been described in a single 2005 case report.² The girl recovered following surgical intervention.

Age

In patients with exposure to toxic plants, 70% are children younger than 5 years.

Clinical

History

In patients with exposure to Caladium, Dieffenbachia, or Philodendron , assess the usual important features associated with toxic environmental exposure, namely, identification of the substance, time and duration of exposure, symptomatology, treatment thus far, associated injuries, and preexisting conditions.

• Identification: If possible, ask the parents to bring in a sample of the plant. Plants often are known by various names, both common and scientific. Identification of the plant is greatly aided by the presence of the plant or a portion of it.
• Time and duration of exposure: Inquire about the level of exposure, including the amount and time of exposure.
• Symptomatology: Patients usually develop immediate burning and irritation of the oral mucosa, which generally deters any further exposure.
• Prior treatment: Patients may have been instructed to try demulcifying agents (eg, cold milk, ice cream) or may have taken analgesics prior to presentation.
• Associated injuries
  • Inquire about any other potential exposures or injury. Often, more than one plant is present in the immediate vicinity.
  • Children also may have fallen or bitten their lips in association with the pain or swelling.
• Preexisting conditions: Inquire about past medical history, medications, and allergies.

Physical

• Assess airway patency; however, swelling severe enough to cause airway compromise is extremely uncommon. Breathing and circulation are usually unaffected.
• Children who chew the leaves develop immediate burning and irritation of the oral mucosa, which may be red and edematous. Many children exhibit mild transient drooling. Severe swelling, drooling, dysphagia, and respiratory compromise have been reported but are not common.
• Cutaneous exposure can cause redness and irritation but is not nearly as common as oral exposure caused by chewing.
• Ocular exposure may result in eye pain, redness, and lid swelling.

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