Plant Poisoning: Quinolizidine and Isoquinoline Clinical Presentation

For all ingestions, obtain as complete a history as possible, including the following:

• Medications
• Allergies
• Suspected ingestion
• Time of ingestion
• Possible co-ingestions

Identify the plant ingested if possible. An on-site plant reference text and an established relationship with an emergency plant taxonomy consultant are useful resources.

Patients with celandine-induced hepatotoxicity may report nausea, vomiting, night sweats, pruritis, rash, fatigue, jaundice, and dark brown urine. In patients taking celandine preparations, these symptoms may occur in a tight time relationship to preparation usage.

Patients with cytisine ingestion (ie, Baptisia, Cytisus, Laburnum, and Sophora species) may complain of the following:

• Vomiting
• Diarrhea
• GI cramping
• Palpitations
• Confusion
• Tremor
• Weakness

Patients who have ingested Sophora root may complain of the following:

• Excessive salivation
• Abnormal gait
• Shortness of breath
• Muscle spasm
• Dizziness
• Palpitations
• Nausea
• Vomiting
• Constipation

Reduced libido and impotence have been reported with Sophora root ingestion, though those cases involved the use of formulations containing other herbs. Three case reports of adverse effects after ingestion of 60 g of Sophora root extract suggest that significant toxicity may occur at that dose. ^[12]

Following argemone oil poisoning, patients may complain of the following:

• Whole-body swelling
• Headache
• Vomiting
• Diarrhea
• Shortness of breath

Following ingestion of Lupinus alkaloids, patients may complain of anticholinergic symptoms such as the following:

• Blurry vision
• Dry mouth
• Confusion
• Palpitations
• Flushing
• Fever

Following ingestion of tea made from opium poppy seeds, patients may complain of drowsiness and weakness. Occasionally, these symptoms can progress to respiratory arrest and death. ^[13]

Celandine ingestion may result in cholestatic hepatitis with jaundice and bilirubinuria.

Cytisine ingestion causes a nicotinic toxidrome with the following manifestations:

• Hyperactive bowel sounds
• Vomiting
• Diarrhea
• Fasciculations
• Weakness
• Diaphoresis
• Mydriasis
• Seizures
• Coma

Sophora root ingestion may be associated with the following:

• Vomiting
• CNS agitation or depression
• Ataxia
• Diaphoresis
• Seizures
• Respiratory depression

Physical examination following argemone oil ingestion may reveal the following:

• Pitting edema of the extremities
• Rales or rhonchi consistent with pulmonary edema
• Flushing of the skin
• Hypotension
• Vomiting
• Diarrhea

Exposure to morphine and papaverine from poppy seeds can produce the typical signs of opioid toxidrome, as follows ^[13] :

• Depressed mental status
• Miosis
• Mild hypotension and bradycardia
• Respiratory failure