Fast Five Quiz: Toxic Plants

Richard H. Sinert, DO

Disclosures

November 23, 2021

Cardiac glycosides are found in a diverse group of plants, including:

  • Foxgloves (Digitalis purpurea and Digitalis lanata) (See image below.)

  • Common oleander (Nerium oleander)

  • Yellow oleander (Thevetia peruviana)

  • Lily of the valley (Convallaria majalis)

  • Squill (Urginea maritima and Urginea indica)

  • Ouabain (Strophanthus gratus)

  • Dogbane (Apocynum cannabinum)

  • Wallflower (Cheiranthus cheiri)

Figure 3. Foxgloves.

Cardiac glycoside plant poisoning typically begins with gastrointestinal (GI) symptoms (nausea, vomiting), which are followed by bradycardia, dysrhythmias, hypotension, hyperkalemia, and altered mental status. Although acute and chronic plant cardiac glycoside toxicity are treated in similar manners, their noncardiac clinical manifestations differ. In acute toxicity, the following may be present:

  • GI symptoms: usually evolve within minutes to hours, are nonspecific, and include nausea, vomiting, and abdominal pain

  • Neurologic symptoms: often nonspecific and include weakness and altered mental status (eg, disorientation, confusion, lethargy)

In chronic toxicity, signs and symptoms are insidious, which can make diagnosis difficult. GI symptoms are nonspecific and include:

  • Anorexia

  • Nausea

  • Vomiting

  • Diarrhea

  • Abdominal pain

  • Weight loss

Neurologic symptoms include:

  • Confusion

  • Drowsiness

  • Disorientation

  • Delirium

  • Headache

  • Hallucinations

  • Seizures

Visual disturbances manifest as:

  • Photophobia

  • Blurry vision

  • Scotomas

  • Decreased visual acuity

  • Color vision aberrations (eg, chromatopsia, xanthopsia [ie, yellow halos around lights])

Cardiac symptoms are similar in both acute and chronic toxicity and include:

  • Palpitations

  • Chest pressure or shortness of breath

  • Lightheadedness, dizziness, and faintness

Learn more about the presentation of cardiac glycoside plant poisoning.

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