Practice Essentials
Plant exposures are some of the most frequent poisonings reported to poison control centers. Exposures to plants containing oxalate crystals, such as Philodendron and Dieffenbachia, are among the most common toxic plant exposures reported in the United States.
For the past 200 years, the irritant properties of the Dieffenbachia plant have had various uses, including punishing slaves and treating gout, impotence, and frigidity. Today, plants containing oxalate are admired for their ornamental beauty and found in public places and homes.
The following plants contain oxalates:
-
Anthurium ( Anthurium species) [1]
-
Arum, Araceae ( Arisaema species)
-
Caladium ( Caladium bicolor) (see the image below)
-
-
Calla lily ( Zantedeschia species)
-
Chinese evergreen ( Aglaonema species)
-
Dieffenbachia ( Dieffenbachia species) [2] (see the image below)
-
-
Jack-in-the pulpit ( Arisaema triphyllum) (see the image below)
-
-
Monstera, Ceriman ( Monstera deliciosa) (see the image below)
-
-
Nephthytis ( Syngonium podophyllum)
-
Philodendron ( Philodendron species) (see the image below)
-
-
Pothos or Hunter's robe ( Epipremnum aureum)
-
Skunk cabbage ( Symplocarpus foetidus) (see the images below)
-
Pathophysiology
Nonsoluble calcium oxalate crystals are found in plant stems, roots, and leaves. The stalk of the Dieffenbachia plant produces the most severe reactions. These needlelike crystals produce pain and edema when they contact lips, tongue, oral mucosa, conjunctiva, or skin. [3] Edema primarily is due to direct trauma from the needlelike crystals and, to a lesser extent, by other plant toxins (eg, bradykinins, enzymes). [4, 5]
Epidemiology
Philodendron and Dieffenbachia exposures are among the most common plant exposures reported to poison control centers. According to the 2018 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS), 4509 single exposures were documented for oxalate plant poisonings. [6]
The majority of oxalate plant exposures occur in children younger than 5 years while sampling houseplants in the home. The 2018 Annual Report of the American Association of Poison Control Centers' NPDS reported 3225 oxalate plant exposures in those younger than 6 years, 706 exposures in those aged 6-19 years, and 449 exposures in those older than 19 years. [6]
Prognosis
Most patients who have been exposed to plants containing oxalates completely recover. In most cases, nonsoluble oxalate plants produce self-limited symptoms and clinical manifestations. Significant morbidity or mortality is extremely rare. However, there are case reports of severe oropharyngeal inflammation and edema, with impending obstruction of the upper airways. [7]
The 2018 Annual Report of the American Association of Poison Control Centers' NPDS reported 878 minor outcomes, 49 moderate outcomes, no major outcomes, and no deaths from oxalate plant exposures. [6]
-
Jack-in-the-Pulpit
-
Skunk Cabbage
-
Skunk Cabbage
-
Dieffenbachia, commonly known as dumb cane
-
Caladium
-
Philodendron
-
Monstera deliciosa
