Spring-Blooming Bulbs: a Year-Round Problem Camilla L
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TOXICOLOGY BRIEF PEER-REVIEWED Spring-blooming bulbs: A year-round problem Camilla L. Lieske, DVM, MPVM ulbous flowering plants are popular for beau- Examples of plants in this category are Hyacinthus tifying the home and garden, but these plants (hyacinth; Figures 1A & 1B), Narcissus (daffodil, jon- B or their bulbs can pose a toxic threat to pets. quil, narcissus; Figures 2 & 3), and Tulipa (tulip) In addition to the bulbs themselves potentially acting species. Dermatitis has been reported in people work- as foreign body obstructions (especially if they are in- ing in occupations associated with the flower industry, gested whole), compounds within the bulbs, leaves, especially in flower pickers.1,2 There is evidence that flowers, or stems can have a variety of toxic effects the effect in Tulipa and Hyacinthus species is due to on animals. Dogs may be more likely to ingest the contact allergens found in the sap of the plants (tulipo- plants than are other pets. Although most of these side A in Tulipa species, an unknown compound in plants grow and flower during the spring, they pre- Hyacinthus species).2 Another mechanism that con- sent a year-round toxic threat: in the autumn during tributes to the dermatitis seen with Hyacinthus species the planting season, in the spring while they are is mechanical irritation due to calcium oxalate raphides growing, or anytime bulbs are grown in pots inside (needlelike crystals).3 the home. Dermatitis caused by Narcissus species also appears The term bulb technically includes only plants with to be an irritant condition resulting from exposure to underground stems surrounded by modified leaves calcium oxalate raphides found in the plant’s sap. Each called scales, which store nutrients. However, garden- species of Narcissus has a different severity of effect. ers commonly apply the term to any plant with a bul- Narcissus pseudonarcissus (daffodil) has the most se- bous root (or underground stem), be it a corm, tuber, vere effects, while Narcissus tazetta (paper white) rhizome, or true bulb. rarely results in problems.1 Although no dermatitis This article discusses the effects of some of the cases in animals have been reported for these plants, more common spring-blooming bulbous plants. Al- there have been reported cases of dermatitis with though most of these plants belong to the Iridaceae amaryllis, a related plant.4 and Liliaceae families, their toxic effects vary. These Clinical signs of contact dermatitis generally re- effects are summarized in Table 1. The plants are solve by eliminating exposure. Bathing in a mild sorted and discussed based on their clinical effects: shampoo and using humectants may be beneficial in contact dermatitis, mild to moderate gastrointestinal severe cases. (GI) irritation, moderate to severe GI irritation or dam- age, severe multisystemic signs, and cardiotoxic signs. Mild to moderate GI irritation Plants with more than one effect are discussed in mul- Plants that can cause mild to moderate GI signs in- tiple categories. clude Crocus species (crocus; Figure 4 ), Galanthus ni- valis (snowdrop), Hyacinthus species, Muscari arme- Contact dermatitis niacum (grape hyacinth; Figure 3), and Tulipa species. In addition to GI signs resulting from ingestion, several Although severe signs are not expected, ingesting bulbous plants are associated with contact dermatitis. large amounts of plant or bulb material from these species may result in GI irritation. “Toxicology Brief” was contributed by Camilla L. Lieske, DVM, Galanthus species contain several alkaloids, in- MPVM, Department of Veterinary Biosciences, College of cluding lycorine found also in Narcissus species (see 3 Veterinary Medicine, University of Illinois, Urbana, IL 61802. The below), located mostly in the bulb. Tulipa species department editor is Petra A. Volmer, DVM, MS, DABVT, College of contain compounds that may act as contact irritants Veterinary Medicine, University of Illinois, Urbana, IL 61802. Dr. or allergens, including tulipalin A and B and tulipo- 2,3 Volmer is also a diplomate of the American Board of Toxicology. side A, concentrated in the bulb. The toxic agents in Hyacinthus species, M. armeniacum, and Crocus 580 AUGUST 2002 Veterinary Medicine TOXICOLOGY BRIEF Continued FIGURE 1A FIGURE 1B FIGURE 2 1A & 1B. These blue (1A) and white (1B) hyacinths can FIGURE 3 FIGURE 4 cause contact dermatitis and mild or moderate GI signs. 2. This cat is close to two toxic plants. The daffodils on the right can cause contact dermatitis and moderate or severe GI signs. The lilies of the valley on the left can be cardiotoxic. 3. Two toxic plants in one arrangement. The yellow daffodils in the center can cause contact dermatitis and moderate or severe GI signs. The grape hyacinths on the edges can cause mild or moderate GI signs. 4. This crocus plant can cause mild or moderate GI signs if ingested. species have not been well-described. Although the most common Crocus species are Clinical signs in animals include nausea, vomiting, spring-blooming, there are Crocus species that bloom and diarrhea (ASPCA Animal Poison Control Center in the autumn, such as Crocus sativus (saffron) and [APCC] Database: Unpublished data, 2002).3 Unless an Crocus speciosus.7 It is important not to confuse the animal ingests large amounts, treatment at a veteri- Crocus species with the Colchicum species, both nary clinic is usually not needed. Activated charcoal commonly called autumn crocus. Crocus species in- (1 to 4 g/kg orally in 50 to 200 ml water5) may be gestions generally will not cause more than mild GI beneficial in cases of recent ingestions. To prevent signs; however, ingestions of Colchicum species may vomiting that often occurs with large initial doses, result in death (see below). Crocus and Colchicum start at the low end of the dose and repeat it. Treat- species may be distinguished by the size of the plant. ment is otherwise symptomatic: antiemetics (metoclo- Although there are some exceptions, Crocus species pramide hydrochloride 0.2 to 0.4 mg/kg t.i.d. to q.i.d. generally do not grow larger than 6 in tall, while orally, subcutaneously, or intramuscularly, or 0.01 to Colchicum species are most commonly 8 to 12 in 0.02 mg/kg/hr as a continuous intravenous infusion)6 tall.7 Because of the potential lethality of Colchicum and GI tract protectants (attapulgite [Kaopectate] 1 to species ingestion, assume all autumn-blooming cro- 2 ml/kg orally every four to six hours or sucralfate cus ingestions are Colchicum species, unless there is 0.5 to 1 g [dogs], 0.25 to 0.5 g [cats] orally b.i.d. to certainty that the ingestion was Crocus species. t.i.d.).6 Also monitor animals for dehydration if pro- tracted vomiting and diarrhea develop. Moderate to severe GI irritation or damage Keep in mind that crocus is commonly used to Plants that can cause moderate to severe GI signs in- refer to two genera of plants, Crocus and Colchicum. clude Cyclamen species (cyclamen), Gladiolus Continued on page 583. 582 AUGUST 2002 Veterinary Medicine TOXICOLOGY BRIEF TABLE 1 Bulbous Flowering Plants and Their Clinical Adverse Effects* Scientific Name Common Name Family Adverse Effects Toxic Agent Arisaema triphyllum Jack-in-the-pulpit Araceae Oral swelling, Calcium oxalate raphides hypersalivation, gastritis, GI ulceration, dyspnea Colchicum autumnale Autumn crocus, meadow Liliaceae Vomiting, hemorrhagic Colchicine saffron diarrhea, ataxia, paresis, liver and kidney failure, death Convallaria majalis Lily of the valley Liliaceae Vomiting, diarrhea (may Cardenolides be hemorrhagic), cardiac arrhythmias, seizures, death Crocus species Crocus, saffron Iridaceae Vomiting, diarrhea Unknown Cyclamen species Cyclamen Primulaceae Vomiting, diarrhea (may Saponins (glycosides) be hemorrhagic); possible cardiac arrhythmias and seizures Galanthus nivalis Snowdrop Liliaceae Vomiting, diarrhea Alkaloids Gladiolus species Gladiola Iridaceae Hypersalivation, severe Unknown gastritis, GI ulceration Gloriosa superba Glory lily Liliaceae Vomiting, hemorrhagic Colchicine diarrhea, ataxia, paresis, liver and kidney failure, death Hyacinthus species Hyacinth Liliaceae Contact dermatitis, Unknown vomiting, diarrhea Iris species Iris Iridaceae Hypersalivation, severe Irisin, terpenoids gastritis, GI ulceration, death Muscari armeniacum Grape hyacinth Liliaceae Vomiting, diarrhea Unknown Narcissus species Daffodil, jonquil, Liliaceae Possible contact dermatitis, Calcium oxalate narcissus severe gastritis, GI raphides, alkaloids ulceration, seizures, (lycorine) hypothermia, death Tulipa species Tulip Liliaceae Contact dermatitis, Tuliposide A, tulipalin A vomiting, diarrhea and B *Most are spring-blooming plants with a few exceptions: Gladiolus species are summer-blooming bulbs, but have the same adverse effects as Iris species; Colchicum species are autumn-blooming bulbs, commonly confused with Crocus species; Gloriosa superba are summer-blooming bulbs with the same adverse effects as Colchicum species. Veterinary Medicine AUGUST 2002 583 TOXICOLOGY BRIEF Continued species (gladiola), Iris species (iris), Narcissus species, stomach and small intestine (ASPCA APCC Database: and Arisaema triphyllum (jack-in-the-pulpit). Inges- Unpublished data, 2002).3 In people, Iris species in- tion of any of these plants is likely to result in GI gestions have resulted in a burning sensation in the signs, although the toxic principles for each plant mouth and hypersalivation.3 A case of Iris species in- type are not all the same. The severity of signs de- gestion in calves resulted