Cardiac Glycoside Plant Poisoning Differential Diagnoses

Updated: Mar 28, 2017
  • Author: Raffi Kapitanyan, MD; Chief Editor: Michael A Miller, MD  more...
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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:

  • Trauma
  • Infection
  • Psychogenic causes
  • Seizure/syncope
  • Alcohol
  • Encephalopathy/endocrinopathy/electrolytes
  • Insulin
  • Opiates
  • 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:

  • Aconitum napellus (monkshood) and other Aconitum species
  • Veratrum album (and other veratridine alkaloids)
  • Yew ( Taxus brevifolia)
  • 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