Plant Poisoning, Caladium, Dieffenbachia, and Philodendron

Updated: Dec 22, 2019
  • Author: Christopher P Holstege, MD; Chief Editor: Timothy E Corden, MD  more...
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Overview

Practice Essentials

According to the 2017 annual report of the American Association of Poison Control Centers' National Poison Data System, 1,858,385 single exposures to nonpharmaceuticals and pharmaceuticals were reported, of which 44,089 (2.4%) were exposures to plants. [1] Children younger than 6 years were responsible for 26,889 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 are commonly found in homes, offices, and waiting rooms. See the images below.

Dieffenbachia. Dieffenbachia.
Philodendron. Philodendron.

Common names for these plants include the following:

  • Spathiphyllum – Spath, peace lily

  • Euphorbia pulcherrima Poinsettia, Christmas flower, lobster plant

  • Ilex Holly

  • PhilodendronCordaturn, horsehead, red emerald, red princess

  • DieffenbachiaDumbcane

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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

In 2017, the American Association of Poison Control Centers reported 4844 single exposures to plants containing oxalates. Children younger than 6 years accounted for 3557 of those exposures. [1]

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]

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Prognosis

Patients with Caladium, Dieffenbachia, or Philodendron toxicity have an excellent prognosis. Although painful, the effects are self-limited. No long-term complications have been reported.

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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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.

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