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Plant Poisoning, Caladium, Dieffenbachia, and Philodendron

  • Author: Jennifer S Boyle, MD, PharmD; Chief Editor: Timothy E Corden, MD  more...
 
Updated: Sep 08, 2015
 

Background

According to the 2013 annual report of the American Association of Poison Control Centers' National Poison Data System, 1,950,455 single exposures to nonpharmaceuticals and pharmaceuticals were reported, of which 43,947 (2.3%) were exposures to plants.[1] Children younger than 6 years were responsible for 28,296 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. See the images below.

Dieffenbachia. Dieffenbachia.
Philodendron. Philodendron.
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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. See the images below.

Caladium. Caladium.
Split leaf philodendron. Split leaf philodendron.
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Epidemiology

Frequency

United States

In 2013, the American Association of Poison Control Centers reported 5248 single exposures to plants containing oxalates. Children younger than 6 years accounted for 3892 of those exposures.[1]

International

The Poisons Information Centre Erfurt in Germany conducted a study of all reported human plan exposures from 2001-2010. The study revealed that severe symptoms occurred more frequently in adults as a result of intentional plant exposure or the mistaken eating of poisonous plants. The higher involvement of children still resulted in mild symptoms.[2]

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.[3] The girl recovered following surgical intervention.

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Contributor Information and Disclosures
Author

Jennifer S Boyle, MD, PharmD Consulting Staff, Emergency Medicine/Medical Toxicology, Salem Veterans Affairs Medical Center

Jennifer S Boyle, MD, PharmD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher P Holstege, MD Professor of Emergency Medicine and Pediatrics, University of Virginia School of Medicine; Chief, Division of Medical Toxicology, Center of Clinical Toxicology; Medical Director, Blue Ridge Poison Center

Christopher P Holstege, MD is a member of the following medical societies: American Academy of Clinical Toxicology, Medical Society of Virginia, Society of Toxicology, Wilderness Medical Society, European Association of Poisons Centres and Clinical Toxicologists, American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center

Disclosure: Received salary from Merck for employment.

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, Wisconsin Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Michael E Mullins, MD Assistant Professor, Division of Emergency Medicine, Washington University in St Louis School of Medicine; Attending Physician, Emergency Department, Barnes-Jewish Hospital

Michael E Mullins, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians

Disclosure: Received stock ownership from Johnson & Johnson for none; Received stock ownership from Savient Pharmaceuticals for none.

References
  1. Mowry JB, Spyker DA, Cantilena LR Jr, McMillan N, Ford M. 2013 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 31st Annual Report. Clin Toxicol (Phila). 2014 Dec. 52 (10):1032-283. [Medline]. [Full Text].

  2. Plenert B, Prasa D, Hentschel H, Deters M. Plant exposures reported to the Poisons Information Centre Erfurt from 2001-2010. Planta Med. 2012 Mar. 78(5):401-8. [Medline].

  3. 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. 2005 Jun. 40(6):e29-31. [Medline].

  4. Altin G, Sanli A, Erdogan BA, Paksoy M, Aydin S, Altintoprak N. Severe destruction of the upper respiratory structures after brief exposure to a dieffenbachia plant. J Craniofac Surg. 2013 May. 24(3):e245-7. [Medline].

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

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

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

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

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

  10. 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. 1981 May. 58(3):444-51. [Medline].

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

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

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

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

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

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

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

 
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Dieffenbachia.
Caladium.
Philodendron.
Split leaf philodendron.
 
 
 
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