Cardiac Glycoside Plant Poisoning Differential Diagnoses

Updated: Jan 23, 2021
  • Author: Raffi Kapitanyan, MD; Chief Editor: Michael A Miller, MD  more...
  • Print
DDx

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