Diagnostic Considerations
In the differential diagnosis, consider entities in which GI upset is associated with hypotension, dysrhythmias (eg, bradycardias, tachycardias), or altered mental status; these are described by the acronym TIPS AEIOU, as follows:
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Trauma
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Infection
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Psychogenic causes
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Seizure/syncope
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Alcohol
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Encephalopathy/endocrinopathy/electrolytes
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Insulin
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Opiates
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Uremia
Consider co-ingestants. Address the possibility of intentional ingestion as a suicide attempt.
Other plants that may produce similar cardiac effects include the following:
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Aconitum napellus (monkshood) and other Aconitum species
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Veratrum album (and other veratridine alkaloids)
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Yew (Taxus brevifolia)
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Rhododendron (grayanotoxins)
The cane toad (Bufo marinus) contains the cardioactive compound bufadienolide in its dried secretions. [2] Dried toad venom is used in China as a traditional medicine known as chan su and is a major component of kyushin, another popular herbal medication used in Asia. Its ingestion has resulted in cardiac glycoside toxicity.
Differential Diagnoses
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Child Abuse
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First-Degree Atrioventricular Block
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Herb Poisoning
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Munchausen Syndrome
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Pediatric Gastroenteritis
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The plant shown is foxglove (Digitalis purpurea), which contains cardiac glycosides, not tropane alkaloids. © 2000 Richard Wagner