Oxalate Poisoning Treatment & Management

  • Author: Jason F Kearney, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Mar 9, 2011
 

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.
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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.

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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.

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Contributor Information and Disclosures
Author

Jason F Kearney, MD  Consulting Staff, Department of Emergency Medicine, Emergency Medicine Associates, PC, Southwest Washington Medical Center

Jason F Kearney, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

William K Chiang, MD  Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center

William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT  Associate Clinical Professor; Medical and Managing Director, South Texas Poison Center, Department of Surgery/Emergency Medicine and Toxicology, University of Texas Health Science Center at San Antonio

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Clinical Toxicologists, American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, Society for Academic Emergency Medicine, and Texas Medical Association

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael Hodgman, MD  Assistant Clinical Professor of Medicine, Department of Emergency Medicine, Bassett Healthcare

Michael Hodgman, MD is a member of the following medical societies: American College of Medical Toxicology, American College of Physicians, Medical Society of the State of New York, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

  1. 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].

  2. Lin TJ, Hung DZ, Hu WH, Yang DY, Wu TC, Deng JF. Calcium oxalate is the main toxic component in clinical presentations of alocasis macrorrhiza (L) Schott and Endl poisonings. Vet Hum Toxicol. Apr 1998;40(2):93-5. [Medline].

  3. Zhong LY, Wu H. [Current researching situation of mucosal irritant compontents in Araceae family plants]. Zhongguo Zhong Yao Za Zhi. Sep 2006;31(18):1561-3. [Medline].

  4. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Giffin SL. 2009 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 27th Annual Report. Clin Toxicol (Phila). Dec 2010;48(10):979-1178. [Medline].

  5. Cheeke PR. Endogenous toxins and mycotoxins in forage grasses and their effects on livestock. J Anim Sci. Mar 1995;73(3):909-18. [Medline]. [Full Text].

  6. Fochtman FW, Manno JE, Winek CL, Cooper JA. Toxicity of the genus Dieffenbachia. Toxicol Appl Pharmacol. Jul 1969;15:38-45. [Medline].

  7. Jaspersen-Schib R, Theus L, Guirguis-Oeschger M, Gossweiler B, Meier-Abt PJ. [Serious plant poisonings in Switzerland 1966-1994. Case analysis from the Swiss Toxicology Information Center]. Schweiz Med Wochenschr. Jun 22 1996;126(25):1085-98. [Medline].

  8. Krenzelok EP, Jacobsen TD, Aronis JM. Plant exposures: a state profile of the most common species. Vet Hum Toxicol. Aug 1996;38(4):289-98. [Medline].

  9. Lampe KF. AMA Handbook of Poisonous and Injurious Plants. AMA; 1985:1-6, 72.

  10. Loretti AP, da Silva Ilha MR, Ribeiro RE. Accidental fatal poisoning of a dog by Dieffenbachia picta (dumb cane). Vet Hum Toxicol. Oct 2003;45(5):233-9. [Medline].

  11. Manríquez O, Varas J, Ríos JC, Concha F, Paris E. Analysis of 156 cases of plant intoxication received in the Toxicologic Information Center at Catholic University of Chile. Vet Hum Toxicol. Feb 2002;44(1):31-2. [Medline].

  12. McIntire MS, Guest JR, Porterfield JF. Philodendron--an infant death. J Toxicol Clin Toxicol. 1990;28(2):177-83. [Medline].

  13. Mitchell JC, Rook A. Botanical Dermatology: Plants and Plant Products. 1979:114-5.

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

  15. Ogzewalla CD, Bonfiglio JF, Sigell LT. Common plants and their toxicity. Pediatr Clin North Am. Dec 1987;34(6):1557-98. [Medline].

  16. Pamies RJ, Powell R, Herold AH, Martinez J III. The dieffenbachia plant. Case history. J Fla Med Assoc. Nov 1992;79(11):760-1. [Medline].

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

  18. Tagwireyi D, Ball DE. The management of Elephant's Ear poisoning. Hum Exp Toxicol. Apr 2001;20(4):189-92. [Medline].

  19. Watson JT, Jones RC, Siston AM, Diaz PS, Gerber SI, Crowe JB. Outbreak of food-borne illness associated with plant material containing raphides. Clin Toxicol (Phila). 2005;43(1):17-21. [Medline].

 
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