Poisoning by Plant Resin

Updated: Feb 12, 2019
  • Author: Hagop A Isnar, MD, FACEP; Chief Editor: Asim Tarabar, MD  more...
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Overview

Practice Essentials

Plants have evolved highly complex systems of defense against most of their natural enemies (eg, insects, animals). At the very least, these defenses make many plants unpalatable; however, some can be fatal to the inexperienced forager. [1]  Resins represent one form of plant defense. See the image below.

Hemlock. Photo by Cornell University Poisonous Pla Hemlock. Photo by Cornell University Poisonous Plants Informational Database.

Throughout human history, plants have played pivotal roles as medicines and poisons. Our medical predecessors may not have known the exact mechanisms involved, but they did recognize various plants as instrumental for medical treatment and as instruments of murder. With current technology, we finally are able to peer into plants and see their vast arsenal of chemicals, including glycosides, alkaloids, oxalates, and resins.

A rapid toxidromic classification of plant poisonings has been developed for use by first responders and other urgent-healthcare providers to assist in rapid identification of poisonous plant–induced toxidromes and to reduce confusion among highly toxic, less toxic, and nontoxic plants. The resultant 4 specific toxidromes of plant poisonings identified in the scientific literature are stratified as cardiotoxic, neurotoxic, cytotoxic, and gastrointestinal/hepatotoxic poisonings, all of which have caused fatalities worldwide after both intentional and unintentional ingestions. [2]

When considering poisoning by plant resin, always be aware of possible co-intoxicants, which may blur the clinical picture. Such co-intoxicants include pharmaceutical and illicit drugs, herbicides, fungicides, insecticides, fertilizers, and artificial plant hormones.

Examples of unintentional toxic plant ingestion include the following:

  • Hikers who mistake poisonous plants for nutritious ones

  • Herbalists who seek natural remedies or natural highs and end up with poisonous concoctions

  • Children who are attracted to brightly colored fruits and leaves of poisonous plants (this group accounts for the most calls to poison centers regarding plant toxicity)

See 11 Common Plants That Can Cause Dangerous Poisonings, a Critical Images slideshow, to help identify plant reactions and poisonings. For patient education information, see the First Aid and Injuries Center, as well as Poisoning and Activated Charcoal.

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Pathophysiology

Resins are a diverse group of chemical compounds that share chemical characteristics, such as insolubility in water, solidity at room temperature, and lack of a nitrogen group. Resin compounds formed with sugars are called glycoresins; those formed with oils are called oleoresins. Latex is a term used to describe these toxins when found in emulsions (ie, urushiols, which are catechol derivatives) [3] in ducts of plants. They are released and activated when structural damage to the plant occurs.

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Epidemiology

While some individuals ingest toxic plants to attempt suicide, most present to the emergency department after unintentional toxic plant ingestion.

The 2017 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS) documented 46,782 plant exposures. The 25 most commonly involved plant species and categories account for 40.6% of all reported plant exposures. Three of the top 5 categories are for unknown plants and comprise 10.6% of exposures. This reflects the difficulty in identification. See the following [4] :

  • Cherry (not otherwise specified) – 2006 exposures
  • Plants, general unknown – 1986
  • Unknown botanical name (unknown toxic types or unknown if toxic) – 1627
  • Botanical terms unknown – 1338
  • Phytolacca americana (L) – 1300
  • Plants, toxicodendrol – 1131
  • Spathiphyllum spp – 862
  • Plants, pokeweed – 856
  • Plants (cardiac glycosides) – 832
  • Ilex spp (not otherwise specified) – 745
  • Berry (not otherwise specified) – 572
  • Malus spp – 524
  • Solanum nigrum – 503
  • Plants, oxalates – 472
  • Caladium spp – 461
  • Euphorbia tirucalli (L) – 458
  • Zantedeschia aethiopica – 444
  • Philodendron spp – 433
  • Unknown botanical name (non-toxic) – 417
  • Solanum dulcamara – 405
  • Mold, food related – 384
  • Epipremnum areum – 381
  • Solanum tuberosum  – 300
  • Crassula argentea  – 276
  • Taxus canadensis  – 265

Approximately 60% of plant exposures reported to poison centers in 2017 involved children younger than 6 years. [4]

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