Plant Poisoning. Dr. Ravi Nanayakkara . Objectives. Introduction, classification and identification of poisonous plants. Circumstances, route of entry, metabolism and excretion of plant poisons.
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Plant Poisoning Dr. Ravi Nanayakkara
Objectives • Introduction, classification and identification of poisonous plants. • Circumstances, route of entry, metabolism and excretion of plant poisons. • Mechanism of action, target organs, clinical features(early and late phase) and principles of management. • Autopsy features(external and internal) and sample collection.
Plant poisoning • More than 300 poisonous plants. • Some are edible. • Act on more than one organ, but act principally on one organ system.
Classification • Neurotoxins • Cardiac toxins • Gastrointestinal irritants • Cellular poisons
Neurotoxins • Datura stramonium • Substances of abuse Canabis sativa Erythrocylon coca Papaver somniferum • Strychnos Nux vomika
Cardiac toxins • Nerium odorum • Thevetia peruviana
Gastro intestinal irritants • Gloria superba • Ricinus communis
Cellular poisons • Manihot utilissma • Adenia palmeta
Datura stramonium • Attana • CNS
Toxic substances • Atropine • Hyoscine • Hyocyamine • Scopolamine All are alkaloids
Circumstances • Accidental –Children eat the seed or fruit Eating the leaves (mistakenly) • Intentional – for revenge, confuse an enemy to robbery – mix with thalaguli during long distance bus travels • Suicidal ingestion rare.
Absorption • GIT • Skin • Mucous membranes
Target Organs - Atropine • brain, heart, smooth muscles, glands • Excretion - Kidney
Clinical features • Shown in the table.
Principles of Management • Eliminate the poison • Phytostigmine to reverse the action • Diazepam to control fits • Manage complications accordingly
Mode of death • Respiratory paralysis Asphyxia
Postmortem finding • Non specific • Seeds or fragments of the plant may be found in the stomach.stomach may show slight inflmmation. • Lungs : pulmonary oedema. • Other organs will show sings of asphyxia.
Specimen collection • Stomach and contents • Intestine • Urine • Blood
Canabis sativa • Ganja – flower • Marijuana – flowery tops / cut leaves • Hashish – dried resin • H oil – oily extract
Toxic substances • Alkaloids • Cannabinol • Cannabidiol • Cannabidiolic acid
Circumstances • Smoking • Beverage • With datura
Clinical features • Inhibitions removed – like alcohol • Confusion • Restlessness • Hallucinations • Narcosis • Nausea • Depression
Principles of management • Symptomatic
Autopsy • Non specific • Features of addiction
Erythrocylon coca • Grows in Central/South America • Toxic Substances • Alkaloid – cocaine • Leaves • Synthetic • Action – stimulates CNS and CVS similarly to adrenalin
Clinical features Shown in the table.
Papaver somniferum(Opium / Heroin) • Unriped capsule of poppy plant • Alkaloids – morphine codeine narcolin papavarin ……
Circumstances • Ingestion • Inhalation • Injections
Clinical features • Excitement – euphoria • Depression of brain stem • Narcosis and death
Strychnos Nux vomikaGoda/Divi kaduru • Spinal stimulant • Commonly found in Southern costal area. • Toxin is mainly found in seeds. • Poison – Strychnine ( an alkaloid)
Circumstances • Accidental – Children eat fruit • Suicidal rare due to bitter • Homicidal rare due to bitter • Abstract of seeds(strychnine) is used to as a rodenticide, kill stray dogs by injecting with a long stick • Homicidal injection - rare
Absorption • All mucosal surfaces • Rapidly absorbed via GIT and spread throughout body
Target organ • Spinal cord and brain
Action • Strychnine stimulate the brain and spinal cord by inhibiting the inhibitory pathways. • Hyperexcitation of brain stem and spinal cord. • Slightest stimulation can cause convulsions.
Clinical features • Bitter taste in mouth • Muscle stiffness • Tremors • Twitching • Convulsions • Concious till death
Management • Maintain airway, breathing, circulation • Control fits • Minimum stimulation Gastric lavarge and vomiting can precipitate convulsion. • Management of complications
Mode of death • Hypoxia to brain stem Respiratory paralysis Asphyxia
Autopsy • Non specific • Asphyxia • Muscle haemorrhages
Cardio vascular system • Thevetia peruviana – Yellow oliander • Nerium oleander – Pink oliander
Circumstances • Suicide-consume fruits • Accidental – any part of the plant (children) • Homicidal-rare
Toxic substance • Cardiac glycosides – digitalis like action • Inhibit Na+/K+ ATPase • Alteration of membrane potential in myocardium and neurones • Increse cardiac Excitability Contractility Automaticity
Route of absorption • GIT-injestion
Target organs • Heart (mainly) - Arrhythmias • CNS - Neuronal excitability depression • GIT-irritant
Clinical features • Faintishness,papitation, irregular pulse,hypotensoin • Yellow vision,blurred vision,dilated pupils, muscular twiching,tetanic spasms,anxiety, confusion • Nausea,vomiting • Pain in throat and numbness in tongue and lips,abdominal pain,profuse salivation
Principles of management • Emesis • Activated charcoal • Antidote-Kaneru tab (Antibody against cardiac glycosides) • Management of complications