eMedicine Specialties > Emergency Medicine > Toxicology
Plant Poisoning, Oxalates: Treatment & Medication
Updated: May 27, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Prehospital Care
- Decontaminate mouth, eye, and skin by physically removing all plant material.
- Treat eye and skin exposure with copious water irrigation.
- Rescuers should protect themselves from contact with plant materials.
Emergency Department Care
Most exposures are self-limited and only require analgesics for patient comfort.
- For oral exposures, physically remove any plant material in the oral cavity.
- Assess for any airway compromise.
- Individuals without airway compromise can drink cold liquids and eat crushed ice, ice cream, or frozen ice pops or desserts for relief.
- Oral swishing with diphenhydramine elixir provides local anesthetic and antihistaminic effects.
- Individuals with laryngeal edema may be treated with antihistamines and observed and/or admitted until edema improves.
- No clinical data support use of steroids in laryngeal edema induced by oxalate-containing plants.
- Treat eye exposures with copious water irrigation. Employ slit lamp examination and fluorescein staining to rule out corneal involvement.
- Skin exposures require irrigation with fluid and local wound care. Some individuals may develop a contact dermatitis.
Consultations
Nearly all cases of houseplant exposures involving oxalate-containing plant species are managed at home in consultation with a regional poison control center. Poison control centers may be helpful with plant identification, particularly if a fax copy or digital picture of the plant can be transmitted.
Medication
Analgesics may be required for pain.
Analgesics
Pain control is essential to quality patient care. Analgesics ensure patient comfort, which is beneficial for patients who have sustained trauma or sustained injuries.
Acetaminophen (Tylenol)
DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, with upper GI disease, or who are taking oral anticoagulants.
Adult
650 mg PO/PR q4h prn
Pediatric
15 mg/kg/dose PO/PR q4h prn
Rifampin can reduce analgesic effects of acetaminophen; coadministration with barbiturates, carbamazepine, hydantoins, and isoniazid may increase hepatotoxicity
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Hepatotoxicity possible in patients with chronic alcoholism following various dose levels; severe or recurrent pain or high or continued fever may indicate serious illness; APAP is contained in many OTC products and combined use with these products may result in cumulative APAP doses exceeding recommended maximum dose (4 g/d)
Ibuprofen (Motrin, Advil)
DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Adult
200-600 mg PO qid prn
Pediatric
5-10 mg/kg PO q6h prn
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor PT closely (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity; peptic ulcer disease, recent GI bleeding or perforation; renal insufficiency; high risk of bleeding
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Category D in third trimester of pregnancy; caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy
Antihistamines
Treatment for significant oral and/or laryngeal edema.
Diphenhydramine (Benadryl)
For symptomatic relief of symptoms caused by release of histamine.
Adult
25-50 mg PO/IV/IM q6h
5 mL of diphenhydramine elixir as oral swish q2h prn
Pediatric
5 mg/kg/d PO/IV/IM divided qid
Potentiates effect of CNS depressants; because of alcohol content, do not give syrup dosage form to patient taking medications that can cause disulfiramlike reactions
Documented hypersensitivity; MAOIs
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
May exacerbate angle-closure glaucoma, hyperthyroidism, peptic ulcer, and urinary tract obstruction; first trimester of pregnancy
More on Plant Poisoning, Oxalates |
| Overview: Plant Poisoning, Oxalates |
| Differential Diagnoses & Workup: Plant Poisoning, Oxalates |
 Treatment & Medication: Plant Poisoning, Oxalates |
| Follow-up: Plant Poisoning, Oxalates |
| Multimedia: Plant Poisoning, Oxalates |
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References
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Further Reading
Keywords
plant poisoning, poisonous plant, toxic plants, oxalate crystals, oxalate exposures, Philodendron, Dieffenbachia, Anthurium, Anthurium species, Arum, Araceae, Arisaema species, Caladium, Caladium bicolor, Calla lily, Zantedeschia species, Chinese evergreen, Aglaonema species, Dieffenbachia, Dieffenbachia species, Jack-in-the pulpit, Arisaema triphyllum, Monstera, Ceriman, Monstera deliciosa, Nephthytis, Syngonium podophyllum, Philodendron, Philodendron species, Pothos or Hunter's robe, Epipremnum aureum, skunk cabbage, Symplocarpus foetidus
