Poisonous Plants

The separation of scientific fact from fic- Unbelievable chaos reigns in the an- 1 of tion is extremely difficult in the study of plant identification and nomenclature as poisonous plants. Examination of the per- applied by nonspecialists. In certain local- tinent literature reveals cor.siderah con- ities, poison dogwood refers not to a spe- fusion that tends to mask an even greater ciS of Corn us but to poison sumac (Toxi- amount of ignorance. Indeed, almost any codendron z'ernzx). Deadly nightshade is a plant may be judged toxic, questionabIc common pharmaceutic svronvm for Atropa or edible, depending on the reference con- belladonna, but in the Pacific Nox thw f it sulted. For example, perhaps the most fa- is often applied to Solanurn dulcamara. mous cookbook in the world, L.2roussc Gas- Deadly nightshade is also known as Eu- tronomique, once declared that rhubarb ropean bittersweet, not to be confused leaves could be 'eaten like spinach," but with Celastrus scandens or Euonyrnus spe- well-documented fatalities resulting from cies, which are also called bittersweet. On their ingestion, both by human beings and the other hand, belladonna may designate by animals, have long been known to the not only the Airopa species of that name medical profession. but also an Amaryllis species. One can only J.M. Kingsbury, who has written exten- guess whether a reported case of poisoning sively on the subject, points out that com- by elephant's-ears refers to a species of pilers dealing with poisonous plants often Caladium, Colocasia, Dieffenhachia, or to felt obligated to carry a plant into newer mandrake, a name applied to some ele- literature even though uncertain of the phant's-ear and to Podophyllum peltaturn original authority. He concludes that only and Mandragora of,ficinarurn as well. When about one half of the names in current it comes to the application of common American compilations are based on do- names to mushrooms, which were proba- mestic experimental or case evidence. The bly not identified correctly in the first place, remainder have been copied from Euro- the situation becomes almost hopeless. pean sources which, in some cases, date This field is where the practicing phar- back to Dioscorides (first century AD.). S. B. macist, in his ever-expanding clinical role O'Leary cites an incident in which "teen- of adviser to both the physician and the age soldiers in Hawaii" were fatally poisoned by oleander juice from sticks used layman, can make an outstanding contri- as toasting forks. This passage may ac- bution to public health and community tually refer to the death of 8 French soldiers welfare. No other professional in the who cooked their meat ration on oleander he4lth field has so extensive a background sticks during the Napoleonic campaigns in in both the botany and chemistry of plants Spain in 1808. as the pharmacist. By virtue of his scientific 438 POISONOUS PLANTS 439 training in these areas, the pharmacist is the only readily available authority on mat- ters of identification and nature of the prin- ri ciples responsible for the toxic effects of accidentally ingested vegetable materials In smaller communities, where poison control centers do not exist, the pharmacist ma y be the only knowledgeable person in this field. The opportunity to function as a L.J professional adviser to a poison control center offers even greater opportunities for the utilization of professional knowledge. Many of the most dangerous higher plants are cultivated species that exist in numerous varieties. Those found in any given community will vary according to climate, geography, and proximity to certain seed houses or nurseries. To serve to best ad- vantage, the pharmacist should endeavor to become thoroughly familiar with both the indigenous and the cultivated flora of his community. Poison antidote kits contain ipecac syrup as well as activated charcoal to be used as Fig. 15-1. Jequirit-v seed, magnified 3 times. directed by the physician to counteract the effects of poisonous substances, Each kit contains a one-half-ounce bottle of ipecac AL'rus is Greek and means graceful, in al- syrup and a 5-gram container of activated lusion to the flowers; precatorius is from the charcoal packaged in a plastic box. Latin precor, meaning to pray, because the The following outline of the most im- seeds are used as beads in rosaries. The portant toxic plants found in the United seeds are ovoid, globular, from 5 to 9 mm States can serve as an important basic ref- in length, hard, smooth, and shining. They erence to this field. Because of the space are 2 distinct colors. The lower or hilum limitations inherent in any textbook that portion is purplish black and has a large must cover a broad area, the listing is nei- lenticular scar: the upper portion is scarlet ther complete nor excessively detailed. red; and the testa is shell-like and encloses Many poisonous plants that are of primary a light yellowish brown embryo that has 2 interest as forage crops for animals are not large cotyledons and an incurved radicle mentioned. Students desiring to develop (Fig. 15-4 The seed contains abrin (je- additional competence are urged to consult quiritin), a lectin Or hemagglutin resem- the specialized books and monographs on bling ricin in its physiologic action. It is poisonous plants in the selected reading toxic, is soluble in a solution of sodium list. chloride, and has a melting point of 295° C. Because jequii-ity seeds are colorful and HIGHER PLANTS attractive and because they are made into rosary heads, decorative table pads, neck- Abrus precatorius Lime (jequirity) is a laces, and other types of jewelry, the climbing y fre- shrub common to tropical arid quentl y are handled by small children. One subtropical countries of both hemispheres. must remember that these seeds contain 440 POISONOUS PLANTS the extremely toxic principle, abrin, which No specific antidotes for these toxins have has caused death on numerous occasions. been found; therefore, treatment of akee Aconituw spp. (aconite, monkshood) are poisoning is primarily symptomatic. not commonly implicated in poisoning cases in the United States. They contain CK2 highly toxic diterpenoid alkaloids, includ- / CH2=C NH2 ing the well-known aconitine. Aleurites [ordii Hemsley (Lung-oil tree) is CH—CHr--CH--COOH a small tree cultivated along the Gulf Coast Hypoglycin A that produces brown, pendant, nearly spherical fruits, Commercial lung oil is ob- Cicuti? spp. (water hemlock) include a tained from the seeds which also contain number of species of the genus Cicuta, es- toxic principles that have been defined pecially C. nwculata Linné. They constitute chemically as esters of 16-hydroxyphorhol. the most violently poisonous plants in the Ingestion of a single seed can produce se- North Temperate Zone. The toxic princi- vere gastroenteritis in a human being. ple, cicutoxin, an unsaturated higher al- Albcasia macrorhiza (Linné) Schott and cohol (tran5-heptadeca-8,10,12-triene-4,6- other species of Alocasin are tropical herbs divne-1,14-diol), has been isolated from C. that generally have arrow-shaped leaves z'irosa Linné. it is a violent convulsant that and are grown for their ornamental, often acts directly on the central nervous system. variegated foliage. The plant is an irritant Water hemlock has tuberous roots that poison. owing to the raphides of calcium are often mistaken for edible wild parsnips oxalatcontained in the sap as well as to or wild artichokes. Such confusion may an additional unknown toxic ingredient, lead to disaster and emphasizes the folly very likely a protein. of uninformed persons who attempt to col- Atropn belladonna Linné (deadly night- lect wild plants for food. shade) contains tropine alkaloids, espe- Colchicum autuinnale Linné (autumn cro- riallv hyoscyamine (see page 191). cus) contains coichicine (see page 242). Blighia sapidu Koenig (akee) is a small Co1ocasa antiquorurn, Schott and C. escu- tropical tree, widel y cultivated in Florida, lenta Schott (elephant's-ear) are tropical that produces clusters of straw-colored to plants widely cultivated for their large reddish fruit. The fleshy arils of ripe fruits showy leaves. They contain large amounts are commonly eaten after parboiling and of calcium oxalate. frying, but the fruit wall and seeds are Conium maciilaturn Linné (poison hem- toxic. Ingestion of the fruit, especially by lock) is a large herb indigenous to Europe children, produces a condition known as and naturalized in North and South Amer- "vomiting sickness,"' which is character- ica and in various parts of Asia. The plant ized by marked hypoglycemia. The mor- resembles wild carrot (Daucus carota Linné) tality rate is high, ranging from 40 to 80%. but does not possess its hairy stem and Two toxic principles, hvpoglvcin A and leaves. Poison hemlock also has a charac- B, have been isolated from the fruit. H y teristic ''mousey" odor. Its fruits were for- -poglycin A has been characterized as - merly used in medicine. me thy lene - cv ci op ro p vi -1.- - am in op r 0- All parts of the plant are toxic because pionic acid, and hvpoglvcin B is a dipeptide of the presence of several nicotinelike al- formed of hypoglycin A and glutamic acid. kaloids, especially conuine, N-methvl-coni-

HO--OH, (CH.)--C1 C–(CHCH), -CH -CH,.--CH, DF I Cicutoxrn POISONOUS PLANTS 441

me, -y-ccniceine, cohydrine, and pseu- alkaloids that account for their frequent in- doconh rdrine. The juice of poison volvement in the poisoning of livestock hemlock constituted the famdus hemlock and human beings, especially children. potion of the ancient Greeks and was used Dieffenbachia sequine Schott and D. picta to put their criminals to death. It is com- Schott (dumbcane) are common ornamen- monly believed that Socrates was executed tal house plants that grow up to 2 meters by means of a decoctiori of this plant. in height and have large entire leaves that Because of its occurrence as a weed in are either uniformly green or, more com- many parts of the United States and the monly, mottled with white, yellow, or relative attractiveness, especially to chil- other shades of green. Ingestion of the dren, of its leaves, fruits, and root, this leaves results in severe corrosive burns of toxic plant should be recognized by every the oral cavity, esophagus, and stomach pharmacist. It is particularly important to caused by calcium oxalate and, possibly, be able to differentiate poison hemlock by unverified proteinaceous roxios. from other members of the family Umbel- Digitalis purpurea Linné (foxglove) con- liferae, both edible and toxic, that bear a tains cardioactive glycosides, digitoxin, gi- close resemblance. toxin, and others (see page 164). Eupatoriu,n rugosum Houttuyn (white

• CH, snakeroot or richweed) is a showy, her- NiCH CH baceous, erect perennial, attaining a height

H of more than 1 meter. It has opposite, ovate

(-.- )-Coniine to cordate !eaves borne on long petioles and white flowers, small in composite Convallaria majalis Linné (lily-of-the-val- heads, and grouped in open terminal cor- ley) contains cardiac glycosides, especially ymbs. Positive identification of this plant convallatoxin (see page 171). is difficult. The disease known as "milk Daphne mezereum Linné (mezereon) is a sickness," common among the early set- small deciduous shrub with alternate tlers in the United States, has been traced leaves, purple flowers, and scarlet fruits. to the ingestion of dairy products derived This plant and related species of Daphne are from animals poisoned by this plant. An widely cultivated as ornamentals. Appar- incompletely characterized, unstable alco- ently, all parts of all species are toxic, but hol that is designated tremetol and occurs the drupes are particularly attractive to in combination with a resin acid is appar- children. A few of these so-called "berries" ently the toxic principle (Fig. 15-2). can kill a child. The toxic principles of the Euphorbia spp. (spurge) number more plant have been identified as daphnetoxin, than 1000 and range from herbs or shrubs occurring in the bark, and mezerejn, lo- to more or less succulent trees. All contain cated in the fruits. Both are diterpene ester a latex that exudes when the plant is dam- derivatives of daphnane. aged. The latex is highly irritating and Datum spp. (stramonjum, thornapple, often produces vesication from contact and Jamestown weed, jimson weed) contain emesis and purgation from ingestion. tropine alkaloids, especially hyoscyamine These effects are caused by a large number (see page 197 and Fig. 8-7). of different esters of the tetracycic diter- Delphinium spp. (larkspur) include a pmoid phorbol, many of which have also large number 'f annual plants occurring as been shown to act as tumor promoters (co- wd species thrcugh 0 me United States, carcinogens). One of the best .-knJwn spe- especially in the West but also widely cul- cies is Euphorhia puicherrima Wilidenow, th tivated in American gardens. They contain common poinsettia. It is a favorite hc.ise a number of toxic polycyclic diterpenoid plant during Chrim;., iecause of its 442 POISONOUS PLANTS

Fig. 15 . -2. LI;;u((:,,u; ruuc;I,,, (vhit€ siiukcrt,t) Illusra[!ng the terminal cur ynibs ul white c&riio-ite'tIuvers bright red bracts. The toxicit y of poinsettia ployed as an external decoration on build- has apparently been greatly reduced as a ings. Ingestion of the berries by children result of long cultivation. has resulted in fatalities. Their toxicit y is Ge!seiniu in seinpervirens (Li n né) Alton attributed to hederin, a saponiri glycoside. (yellow jasmine) is a perennial woody Hipponiane inancinella Linné (manchineel evergreen climber growing in the moist tree) is a small tropical tree occurring in the woodlands of the southeastern United southern part of Florida. All parts of the States. Its dried rhizome and roots consti- plant contain an extremely caustic, milky tute the crude drug gelsemium, formerly sap whose active principles are a complex employed as a central nervous system de- mixture of esters of the tigliane and daph- pressant. Ingestion of sufficient quantities nane types. Similar compounds have been of the plant may lead to respiratory failure. detected in many other members of the Children have been poisoned by tasting family Euphorbiaceae. the nectar of the flowers, and honey pre- Hyoscyamus niger Linné (henbane) con- pared by bees feeding on the nectar has tains hyoscyamine and scopolamine (see caused fatalities. The active principles are page 197), indole alkaloids, especially gelseiiine and flex aquifolium Linné (English holly) and sempervirine (Fig. 15-3). several related species of Ilex. are small trees Hedera helix Linné (English ivy) is the or shrubs with shiny green leaves and well-known cultivated vine commonly em- bright red berries They are often used as POISONOUS PLANTS 443

Fig. 15-3. Yellow lessamine or yellow jasmine (Gclsowuoi perl rein) is a perennial woody climbing vine growing in the southeastern United States. (Photo courtes y of Dr. Julia F Morton, Director, Morton Cullectanca, University of Miami.)

Christmas decorations. Ingestion of the dodendron (Azalea), are widely occurring berries produces vomiting, diarrhea, and shrubs or small trees. All contain the same "mild narcosis." The active principle re- poisonous principle, acet ylandromedol, a mains uncharacterized. diterpene derivative, That compound has Ipomoea spp. (morning glory) are com- been identified as the toxic agent in honey mon, cultivated ornamental vines. The produced by bees that feed on these plants. seeds of Some species and varieties contain Laburnum a na,c.rvidL'5 i/ Medicus (la- ergot alkaloids, especially engine (see page burnum, golden-chain) is a large orna- 236). mental shrub or small tree that is widely Jatropha curcas Lin n6 and J. in ultifida cultivated as a spectacular ornamental Linné (physic nut) are tropical shrubs or owing to its long, hanging, racemes of small trees occurring with several closely golden yellow flowers. The fruit, a legume related species in Florida, Texas, Puerto pod containing up to 8 seeds, is commonly Rico, and Hawaii. Closely related botani- ingested by children. Laburnum seeds con- cally to the castor plant, these plants pro- tain cytisine, a quinolizidine alkaloid re- duce seeds containing a purgative oil and sembling nicotine in its physiologic effects. a toxic lectin. Lantana caniaoi Linn (lantana) is an or- Ka/nij0 ancusf ffolia Linné (dwarf laurel), namental shrub, up to 1.5 meters in height, K. !atzfo/ja Ljnné (mountain laurel), and with aromatic leaves, orange or bright red certain other members of the Ericaceae, flowers, and dark blue or black fruits such as species of Ledum, Pit'ris, and Rho- (drupes). The plant is widel y cultivated in 444 POISONOUS PLANTS

California and the southern United States, namental bush or shrub with coriaceous, where cases of poisoning have occurred sharply pointed, oblong-lanceolate leaves through ingestion of the fruit. Most au- and showy pink or white blossoms. It is thorities attribute lantana's toxicity to 2 widely cultivated in the southern United pentacyclic triterpenes, lantadene A and B. States and California and is grown else- Others deny this and state that the poi- where as an indoor pot plant. The plant sonou principle is unknown. contains a complex mixture of cardiac gly- Lobelia infiata Linné (Indian tobacco) and cosides derived from 6 different genins that several related species of Lobelia contain pi- are closely related chemically and physio- peridine alkaloids, especially lobeline (see logically to the digitalis glycosides (see 'page 191). page 12). Melia azedurach Linné (chinaberry tree) is Nicotiana spp. (tobacco) contain alka- a small, thickly branched tree with large loids, chiefly nicotine (see page 189). compound leaves, purple flowers, and Papaver spp. (poppy), the related Arge- smooth ovoid fruits (drupes) that are yel- mone mexicana Linné (prickly poppy), and low when mature. The plant is common in Chelidonium majus Liriné (celandine poppy) the southern United States, Puerto Rico, contain isoquinoline alkaloids (see page and Hawaii. Poisoning most often results 208). from ingestion of the fruits whose toxicity Philodendron spp. are perhaps the most is associated with a resinous fraction. Se- Common houseplants in the United States. vere irritation, nervous symptoms, and Like certain other members of the family fatty degeneration of the liver and kidneys Araceae, they may contain irritant princi- characterize the toxic effects. ples (calcium oxalate and others). Numer- Menispermurn canadense Linné (Canada ous cases of poisoning in cats, 50% fatal, moonseed) is a high-climbing vine, indig- have been reported. enous to the northern United States and Phoradendron villosum Nuttall and P. f/a- Canada, that has broadly ovate, cordate, eescens (Pursh) Nuttall (mistletoe) are 3- to 10-lobed leaves, its fruits resemble woody perennial plants growing as para- small purple grapes and have been the sites on oaks and other deciduous trees. cause of poisoning in children. The toxic The latter species is widely employed as a principles are isoquinoline alkaloids, in- Christmas decoration. Leaves, stems, and cluding dauricine which has a curarelike berries of these plants are toxic, owing to action. their content of phoratoxin, a disulfide Metopium toxiferuin Krug et Urban (poi- bond-containing protein found in the sonwood tree) is a large shrub or small tree genus (see page 480), with compound leaves and fleshy fruits, It Phyto/acca americana Linné (pokeweed, is common in areas south of Miami, Flor- pokeberry) is a tall, branched perennial ida, and frequently causes severe contact herb that reaches a height of 3 meters. It dermatitis. Presumably, the active princi- has white or greenish flowers in racemes, ple is identical or at least similar to that of and 10-celled, juicy, purple berries. When urushiol, the causative agent of poison ivy ingested, the various, plant parts produce dermatitis. different degrees of gastrointestinal upset, Narcissus spp. (narcissus, daffodil, jon- accompanied by weakened respiration and quil) are well-known cultivated plants. pulse. The leaves and the roots are espe- Ingestion of narcissus bulbs produces se- cially toxic, the berries much less so, be- vere gastroenteritis and nervous symp- cause of their content of phytolaccatoxin toms, apparently owing to the phenan- and related triterpenes (see page 484). thridine alkaloids contained therein. Podophylluni pc/tat urn Linné (American Neriurn oleander Linné (oleander) is an or- mandrake, mayapple) contains resinous POISONOus PlANTS 445

principles that produce dermatitis on can- contains isoqi4noline alkaloids, especially tact and catharsis on ingestion (see page sanguinarine (see page 212). 141). Skinunia jaonica Thurberg (skimmia) is Poinciana gilliesi Hooker (poinciana, bird an ornamental evergreen shrub with alter- of paradise) is a shrub or small tree with nate simple leaves, small white flowers in Showy terminal racemes of yellow flowers terminal panicles, and bright red berries. with red stamens. In the southern United All parts of the plant are toxic, but the at- States, it i5 cultivated as an outdoor PC- tractive berries are most commonly in- rennial; elsewhere it is grown as a large gested. The active principle is skimmi- indoor plant. The green seed pods are - anine, a furoquinolinc alkaloid that acts as tremely irritating to the digestive tract. This a muscle poison and may cause cardiac or plant should not be confused with Strelit- pulmonary arrest. zia, the florist's bird of paradise flower. Solancira spp. (chalice-vine) are woody, Primula obconica Hance (primrose) is a erect or climbing, tropical plants with large popular house plant that produces a severe white to yellow, showy flowers. Species Contact dermatitis in sensitive individuals encountered in Florida and Californiain- This is attributed to the presence of the dude S. grandiflora Swartz, S. hartwegii N. contact allergen primin, a benzoquinone E. Brown, and S. longiflora Tussac. The derivative found in the glandular hairs that plants contain tropane alkaloids; atropine, occur abundantly on the cal yx and flower hyoscyamine, and norhvoscyamine have stalks of the plant. been isolated from various species. Prunus serotina Ehrhart (wild cherry) and Salanurn sep. (nightshade) are annual or related species and varieties (P. virginiana perennial herbs and shrubs with alternate, Linné, P. laurocerasus Linné, etc.) contain simple or compound leaves and wheel- cyanogenetic glycosides (see page 70). shaped or shallowly bell-shaped flowers, Ranunculus spp. (buttercup, crowfoot) often showy in white, yellow, blue, and are perennial or annual herbs with yellow purple. The fruit is a berry that is often flowers. Some of these species are the most quite attractive. Solanum dulcamara Linné (European bittersweet), S. nigruni Linrié common weeds in fields and marshy areas (black nightshade), and related species, in- in the United States. The juice of these cluding S. plants has vesicant properties owing to the tain toxic steroidaltubemsum glycoalkaloids Linné (potato), (solan- con- presence of a highly unstable -y-lactone, protoanemonin. i, demjssine, others) in the green shoots, Rheum rhapontic leaves, and fruits. The toxicity of a single barb, common rhubarb)Linné (rhapontic rhu- species varies widely according to the part contains large used, the stage of development, and pos- quantities of oxalic acid and its salts in the sibly the genetic factors. Following inges- lamina of the leaf (see page 64). tion, the glycoalkaloids are not readily ab- Rhododendrn spp., see Kabnia twgusti- folia. sorbed, but first undergo hydrolysis to release the free alkamjnes. These are then Rhus spp., see Toxicodendro?l radicans. Ric1nu coinmunjs absorbed, producing nervous symptoms Linné (castor bean) characterized by dulling of the senses and contains ricin, a lectin or hemagglutin, in stupefaction. the seeds (see page 88). Taxus spp. Robinja pseudoacacia (yew) are evergreen trees and Linne (black locust) shrubs with linear leaves that are dark contains a toxic principle in the seeds, green on the upper surface and yellow- leaves, and bark. The toxin, robin, is a 1cc- green on the lower, incons tin, related to abrin in jequirity. picuous flowers, and berrylike red fruits composed of a Sanujnarja canadensjs Linrié (bloodroot) stony seed nearly surrounded by a thick 446 POISONOUS PLANTS

Wisteria spp. (wisteria) are ornamental woody vines with pinnate leaves and drooping terminal racemes of showy flowers, white, pink, blue, or purple in color, followed by fruits that are elongated pods, contracted at intervals. Ingestion of the plant produces mild to severe gastroenteritis, which has been attributed to the presence of wistarin, an uncharacterized glv- coside, and a lectin. Xanthosna sagiftifoliurn (Linné) Schott (malanga) and related species of Xanthosrna fig. 15.-I. ft (VCVy tile are large tropical aroids commonly grown rylike true, and the dark Ston y seed surrounded by as foliage plants. The leaves are extremely the fleshy cup-shaped aril of the fruit. acrid owing to the presence of large amounts of calcium oxalate. fleshy cup. All species of Taxus that have Zctrnia puntila Linné (Florida arrowroot) been investigated contain a complex mix- and other members of the order Cycadales, ture of toxic alkaloids designated taxines in including species of Cycas and Macrozamia, the leaves, bark, and seeds but apparently are primitive cone-bearing palmlike plants not in the pulp of the fruit. Ingestion of 50 indigenous to the tropics but cultivated to 100 needles can produce death in the elsewhere as ornamentals. These cycads human being through cardiac and respi- contain a carcinogenic and hepatotoxic gly- ratory depression (Fig. 15-4). coside, cycasin, which has been character- T/uuetia peruviana Schumacher (yellow ized as methvlazoxymethanoI--D-gluco- side, in some tropical areas, various parts oleander) is a large, cultivated evergreen of cycads are employed for the preparation shrub or small tree with linear, sharply of edible flour, and cases of poisoning pointed leaves, fragrant, showy yellow sometimes result from the ingestion of an flowers, and fruits that are fleshy drupes, improperly prepared product. Acute intox- broadly triangular, and black when ripe. ications resulting from a single ingestion of The plant is cultivated as an ornamental in cvcad roots or seeds are much less com- southern Florida and Hawaii. On the is- mon. land of Oahu it is said to be the most fre- 0 quent cause of serious poisoning in human I beings. Yellow oleander contains cardiac CH—N=N---CH2--0---C6H1101 glycosides (cerebrin, neriiiolin, thevetin) that produce digitalislike effects. Cycasin Toxcodendron radzcans (Linné) Kuntze Zigadenus spp. (death camas) are pe- (poison ivy) as well as other species of the rennial herbs with grasslike leaves; under- genus Tox7codendmn (formerly Rirus), in- ground bulbs or rhizomes; greenish white, chiding 1. diversi/oburn (Torrey et Gray) yellow, or pink flowers; and capsular fruits. Greene (western poison oak), T. quercifol- The plants contain steroidal glycoalkaloids, inn, (Michaux) Greene (eastern poison chemically and physiologically similar to oak), and T. vernix (Linné) Kuntze (poison those of Veratruni viride. sumac), all contain urushiol, a phenolic allergen that produces contact dermatitis (see page 432 and Figs. 15-5 and 15-6). MUSHROOMS Veratruni m'iride Aiton (green hellebore) Because the chemistry of the active prin- contains steroidal alkaloids (see page 238). ciples in many poisonous mushrooms is POISONOUS PLANTS 447

Fig. 15-5. Poison ivy ( 1oxicd 1, smetlne unu5ed witL Virginia creeper (Psede,a quinque- k1,n); the former (left) is 3-foliate and the latter (right) is usuall y 5-foliate or more.

ig. 15--h. [or,cc(ejj r (P ois o mac) differs from the other toxic Thxicotciidron species by its 7- to I nip P t iii 448 POISONOUS PLANTS still imperfectly known and positive botan- ical identification is often extremely difficult, these species must be classified on a physiologic basis, that is, according to the type of symptoms observed in human beings following ingestion. Four basic types of mushroom toxins, with several minor subdivisions, are generally recognized: 1. Protoplasmic poisons a. amatoxins b. gyromitrins c. orellanine (Cortinarin A and B) 2. Compounds exerting neurologic ef- a. muscanne b. ibotenic acid-muscimol c. psilocybin-psiocin 3. Gastrointestinal irritants 4. Coprine All the known poisonous species contain one or more of these principles. The basic Pig. 15-7. A,,iamt.i c ..t;z,: (Justcu\. ing angel) is one classification does not include poisonings the most deadly mush[oorns known. from hypersensitivity to mushroom protein or from eating mushrooms partially decomposed by microbial action. Also omitted are those mushrooms that may be poisonous if eaten in quantity because of room is rare in the United States, appar- their ability to accumulate toxic heavy met- ently existing only as an introduced spe- als from the soil. cies. Related species, including Amanita bisporigera Atkinson, Atnanita verna (Fries) Protoplasmic Poisons Vittadini, and Ainanita virosa Secretan, are Amatoxins. As the name implies, this mix- more common and also contain these tox- ture of peptide toxins was first detected in ins (Fig. 15-7). Amanita brunnescens Atkin- certain species of Ainanita, a genus of son, long confused with Amanita phalloides mushrooms characterized by white spores, in this country and still designated by some the presence of both an annulus and a as a brown form of the latter, does not con- volva, and typically free gills. Certain of tain amatoxins. Although its toxicity has these toxins have been found in some spe- not been scientifically verified, it does con- cies of Galerina, a genus typified by small tain an unidentified alkaloid and is pre- nondescript carpophores with yellowish sumably poisonous. brown spores, whose species are distin- Both a- and 13-amanitin have been de- guished principally on the basis of micro- tected in Galerina autumnalis (Peck) Smith scopic characteristics. & Singer, Galerina marginata (Fries) About a dozen related cyclopeptides, the Kiihner, and Galerina venenata A.H. Smith. most important of which are a-, 13-, and 'y- These species probably constitute a more amanitin, have been isolated from Amanita serious health hazard than do the 'deadly phalloides (Fries) Secretan (deadly amanita) amanitas because of the extreme difficulty of European origin. This particular mush- in identifying them unequivocally and be- POISONOUS PLANTS 449

cause they often Occur in lawns and other species of grassy areas. Gyijrniira and HeIe/1n. These nongilled fungi are characterized by a pi- Regardless of the species involved, poi- leus surface that varies from nearly smooth soning by amatoxins is characterized by a to strongly convoluted. However, it is long latent period between ingestion of the never pitted (distinction from mushrooms and onset of symptoms. An Morchdla species—morels) . Their pilei are nearly'al- asymptomatic latent period lasting up to ways lobed, usually more or less saddle- 24 hours precedes violent vomiting and shaped. diarrhea, which may continue until death Chemically; results. If the patient survives this initial the gyromitrins are N- phs through appropriate therapy, he derivatives of several low-rn. may appear to recover for a short time but olecu1arweight aliphatic al- dehydes. The first isolated was the hydra- generally will relapse owing to progressive zone of acetaidehvde, but at least 3 others injury to the liver, kidneys, heart, and cen- are now known. In the body tral nervous system. Death results in about , they release N-methy1Nf 30% of the cases within 4 to 8 days. orrny1hydrazjjie (MFH) Modern treatment of amatoxin poison- which is oxidized to produce the extremely ing involves removal of the toxic material poisonous N-nitroso-N-methy1foaiide from the gastrointestinal tract, if necessary, (.NMFA). NMFA is essentially hepatotoxic followed by administration of analgesics to but does exert additional effects on the he- control pain, intravenous infusions of liq- matopoietic system and the central nerv- uid to prevent dehydration and shock, he- ous system. Gyrornitrins are, therefore, modialysis or hernoperfusion to eliminate dassed as protoplasmic poisons, but differ the toxins, and appropriate measures to markedly in their chemistry and toxicity from the amatoxjns. maintain a brisk urine flow. Additional treatment is largely symptomatic and sup portive. 0 Some success has apparently been ob- L tained by using intravenous corticosteroids to inhibit toxin fixation in the liver and in- CH1—CH=N—N H travenous penicillin C or thioctic acid (ci- CH lipoic acid) to protect that organ. Admin- istration of cytochrorne C, vitamins C, K, Gyromitrin and B complex, and dextrose and sodium chloride injection have all been reconi- Acetaldehyde N-(formyl .N.methylhydrazone) mended. The compounds that have pro- Gyromitrins and their breakdown prod- duced the greatest survival rate are ucts are volatile which explains why spe- penicillin C, chioramphenicol, phenyihu- cies containing them may be rendered edi- tazone, and a combination of sulfamethox- ble by extended drying or by parboiling. azole and trimethoprim; however, at pres- Both of these procedures destroy more ent, no antidote for amanitjn intoxication than 99% of the mushroom's hydrazine is sufficiently established clinically for content. European specimens of Gyroinitra unequivocal recommendation. ecii1enta contain nearly 10 times as nuich Gyromitrins. A second type of proto- gyromitrins as similar specimens collected plasmic poison, less dangerous than the in the Pacific Northwest region of the amatoxins but still capable of producing fa- United States. Obviously, different chem- tal results, occurs in certain false morels, ical races of the species exist, with marked especially Gyromitra esculenta Fries, but also in G. ,gigas differences in their content of the poison- Cooke and other closely related ous CuflStJtuents 450 POISONOUS PLANTS

A latent period of approximately 6 to 10 may be prolonged for months. About 15% hours usually occurs between ingestion of of the recorded cases have proved fatal. the mushroom and the onset of symptoms Because of the long latent period, treat- that resemble those produced by amatox- ment can only be symptomatic and sup- ins but are generally less severe. Although portive, with particular attention to the cases of poisoning are common in Europe maintenance of kidney function. and often involve large numbers of people, fatal poisonings are rare in the United Compounds Exerting Neurologic Effects States. The mortality rate ranges between Muscarine. Muscarine is a quaternary 15 and 35%. Treatment is similar to that compound originally isolated from Amanita recommended for amatoxin poisoning. muscaria (Fries) Hooker, which occurs in Orellanine (Cortinarin A and B). The third that species and in the closely related type of protoplasmic poisoning is that pro- Amanita pan therina (Fries) Seretan in small duced by the mixture of compounds orig- amounts. It is not, however, the principal inally named orellanjne contained in cer- toxic agent in either of these mushrooms. tain Cortinarius species. It has now been The compound has been reported to occur shown that 2 toxic cyclopeptides desig- in a number of species of Boletus, Lepiotn, nated cortinarin A and B, closely related to Hebelonja, and Russula, but in many cases the amanitins, are the responsible constit- scientific verification is lacking. Certain uents accounting for the mushrooms' poi- species of Clitocybe, and especially Inocybe, sonous nature. Both are active nephrotox- contain muscarine in high concentrations, ins, but cortinarin B is the more toxic of ranging in the latter species to more than the 2. 3% of dry weight when assayed physio- Of the species of Cortinarius examined, logically. Both of these latter genera are only C. orellanus Fries (from which orellan- readily recognized; Clitocybe by its typically me was originally obtained), C. orcllanoidcs white spores, fleshy central stipes, and Henr y , and C. speciosissmus Kühner et broadl y adnate to decurrent gills; Inbcybe Romagnesci have been found to contain by its characteristic subconic to campanu- cortinarin B. However, more than 60 spe- late pileus, somewhat evanescent cortina, cies contained varying amounts of corti- adnate or adnexed gills, and brownish narin A, and their toxicity was shown to spores (Fig. 15--8). be proportional to the sum of the concen- HO trations of cortinarin A and B. Fortunately, ,z_ \ none of the 3 deadly species containing car- tinarin B has ever been found in the United 130 CH3N(CH.)3 States. There is, nevertheless, a possibility L.(-- )-Muscarine that they may occur on the West Coast. Poisoning by cortinarius toxins is char- Symptoms of muscarine poisoning ap- acterized by an extremely long latent pe- pear quite rapidly, usually 15 to 30 minutes riod, varying from 3 to 14 days, between after ingestion. Increased salivation, per- ingestion of the fungus and appearance of spiration, and lacrimation are followed by the symptoms. An intense burning thirst abdominal pain, severe nausea and diar- is first noted, followed by gastrointestinal rhea. The pulse is slowed, the pupil is con- disturbances, headache, pain in the limbs, stricted, and breathing is asthmatic. The spasms, and loss of consciousness. Liver patient's mental processes remain clear. and, particularly, kidney darage occurs Death may result in severe cases from car- and may result in death after se',eral weeks diac or respiratory failure, but it is infre- or longer. Recovery in less severe cases quent. Treatment involves gastric lavage POISONOUS PLANTS 451

J11

'4x_• '4'

r' ...

Fig. 15-8. 1720c111le uappes J Lange carpophnres contain Jare LLLLi Li U 'iiio ortui. y iif D.E. :,,tuntz.)

and administration of atropine, a specific tified as a mixture of 2 isoxat ' 'h deriva- antidote. tives, ibotenic acid and its decarboxylation Ibotenic Acid-Muscimol. Ingestion of cer- product, muscimol. The compounds differ tain species of Amanita (A. nzuscaria, A. little in their qualitative effects, but quan- pantherina) produces symptoms that are titatively, muscimol is at least 5 times as not typical of muscarine, which is present active as ibotenic acid. These 2 psycho- in the species in small amounts, but resem- tropic compounds are accompanied, at ble the central nervous system stimulation least in some specimens of A. muscara, by induced by atroi Travelers in Siberia a third active constituent, muscazone, during the early part of the 18th ntury which is an oxazole derivatic. reported the use of the fly agaric, Amanita Symptoms appear within 30 minutes 19 muscaria, as an intoxicant by tribes of the 2 hours f-Uowing ingestion. These are Kamchatkan Peninsula. Vivid reports of characterized b y initial state of excite- orgies resulting from the use of this mush- ment resembling alcoholic fltoxicatiofl, fol- room are nrl in the older literature (Figs. lowed by muscular twitching, re-,5ion, 15-9, 15-10), and ultimately, loss of consciousp5. HO,0 Death is infrequent and recovery is ordi- N narily rapid. Treatment is largely sympto- -cH—coo N OH NH, matic, employing mild depressants at first, NII followed by stimulants. Ibotenic Acid Mucimot Psiloc'bin-PsiIocin. Ingestion of certain active principle was ultimately iden- small mushrooms not commonly em- q.

452 - POISONOUS PLANTS

Fig. 1-9. Carpophores of Anuinjia muscaria (Fries) Hooker. commonl y known as the fl y agaric. This mushroom has been em•poyed in Siberia as a hailucrnogenic agent. (Photo courtesy of D.E. St-untz.)

I-

Fig. 15-10- Carpuphurc ui Anmi;iia mi; mu 'Fries) Secretat . the panther aga]-ic. Ihe hrmn pileus if this species readily distinguishes it from ,imanita ;uio.no-ia (red or orange pileus). (Photo courtesy of D.E. Siunhi.) POISONOUS PLANTS 453

ployed as food can result in psychotropic Gray, Paxillus invulutus (Fries) Fries, Rho- manifestations in the human being- Most d0pin1I1u Iiidus (Mérat) Quelet (Fig. of them are species of Psiloci11)e and Co,io- 15-12), Russula enieica (Fries) S.F. Gray, cybe [P. cubensis (Earle) Singer, P. lnexicnna and Tricholonia pardinuin Quelet. The chem- Heim, C. cyano pus (Atkinson) Kühner] that ical nature of the active principles of these have been used for many years by Indians species is not known, but they are gener- in southern Mexico in magicoreligious cer- ally presumed to be resinlike substances. emonies. Active members of both genera Symptoms are prompt in onset and in- are brownish and somewhat nondescript clude nausea, vomiting, and diarrhea, in appearance (Fig. 15-11) but are readily ranging from mild to extremely severe. Fa- characterized by the bluish stains that talities have resulted, especially among form, especially near the base of the stipe, children. Rhoda phi,'/lus lividu,s also displays when the tissue is damaged or becomes some hepatotoxic activity. In most cases, aged. Chemical studies have revealed that recovery is spontaneous and complete, but 2 tryptamine derivatives, psilocybin and symptomatic care, bed rest, and a light diet psilocin, are the active principles in these are indicated. mushrooms. Psilocybin has been investigated clinically to determine its value in the Coprine treatment of psychiatric disorders. Ingestion of Coprinus atrarneutarius (Fries) Fries and the concomitant or sub- OH I OH3 sequent ingestion of alcohol give rise to (CH2—CH—N symptoms resembling those of the alcohol- OH disulfiram syndrome. This species is recognized by its black spores, smooth or mi- H nutely scaly grayish pileus, and free gills Psilocin that deliquesce into a dark-colored fluid as the spores are discharged.

0 OH Because of the similarity in its physiologic action to disulfiram or cyanamide, the /CH3 activity of the mushroom has been attrib- N uted to one or the other of these com- CH3 pounds. In 1975, two groups of scientists, H one in the United States and the other in Psi locybin Sweden, independently isolated the toxic constituent, N-( I -hydroxycyclopropyl)-L.. Symptoms of psilocybin poisoning de- glutaminc. This compound has been velop rapidly and continue for several named coprine. hours. Anxiety and difficulty in concentra- tion and in comprehension are common. HA co Both elementary and true hallucinations may be experienced. Recovery is ordinarily spontaneous and complete alter 5 to 10 hours. Copnne Gastrointestinal Irritants The compound itself is inactive, but it Mushrooms containing compounds that breaks down partially in the body to form have an irritating effect on the gastrointes- cyclopropanone hydrate. This interferes tinal tract include such species as Boletus with the function of acetaldeh yde dehy- satanus Lenz, Lactnrjus forininou (Fries) drogenase in the liver. Normal alcohol me- 454 POISONOUS PLANTS

Fig. 15-11. Capophores ci 1',hs.jbc pUicukso A.H. Sinih, This North American halIncingcoic niuIirooni contains Osilocvbin. (Photo courtesy of D.E, Stuntz.)

• •t1. .•.I.

0- ? ' ;

Fig. 15-12. Rhodophillhis Jizu!u (Mérat) QuIct ctrpephores produce gstrointcsEiiuiI opsets with dssociatcd hepatotoxicitv. (Photo courtes y of D.E. StOntL. POISONOUS PLANTS 455 tabolism is thereby retarded and acetal- Howard, R.A., DeWoif, Cr., Jr., and Pride, G.H.: Poisonous Plants, Arnoldia, 34(2):41, 1974. dehyde concentrations in the blood remain Keeler, R.F.: toxins and Teratigens of Higher Plants, abnormally high. Llovdia, 35(l);56, 1975. Symptoms, which occur within one half Kinghorn, AD., ed: Toxic l'lant, New York, Colum- bia University Press, 1979. to 2 hours following consumption of the Kingsbury, JAI.: Poisonous Plants of the United States mushroom and alcohol, include flushing, and Canada. Englewood Cliffs, New Jersey, Pren- palpitations, dyspnea, hyperventilation, tice-Hall, Inc., 1964. Kingsbury, J,M.: Deadly llarr'esf, New York, Holt, and tachycardia. Vomiting and diarrhea Rinehart & Winston. 1955. are usually absent. Recovery is ordinarily lampe, KS., and Fagerstroni, R.: Plant Toxicity and spontaneous and complete, but severe Dermatitis, Baltimore, The Williams & Wilkins Co., 1968. cases may require gastric lavage and symp- Lampe, K. F_ and McCann, MA.: AMA llauidbook of tomatic care. Poiso,un is and fnjurioiis Plants, Chicago, American Medical Association, 1985. and (incitE, C., and Mitchel, Dl-!.: Toxic 1lnllucnu- genie Mushroom i'aisouiin, New York, Van Nos- READING REFERENCES trand Reinhold Co., 1977. McKenny . M., and 5.tuntz, D.F.: The Savory Wild Pci- Ammirati, J.F., Traquair, J.A., and Horgen. PA.: MimIirooun, rev. ed., Seattle. University of Wash- 5000145 Mushrooms of the Northern !Jmtcd Stafes and ington Press, 1971. Canada, Minneapolis, University of Minnesota Morton, ).F.: Poisonous and Injurious Plants and Press, 1985. Fungi. In Fon'iusic Medicine, Vol. Ill, Tedeschi, New Baskin, E.: The Poppy and Other Deadly Plants, CC., Eckert, W.G., and Tedesehi, L.G., eds., York, Delacorte Press, 1967. Philadelphia, W.B. Saunders Co.. 1977. Benedict, R.G. Mushroom Toxins Other Than .'loian- Morton, J F,: Plants Poisonous to People in Florida and Vol. VIII, Kdis, S.A., . ita. In Microbial Toxins, Other Warm lucas, 2nd ed., Miami, Author, 1982. New York, Aca- Ceigler, A., and AI, S.)., eds., Muermscher, 'u'V.C.: Poisonvuss Pla,u?s of time United States, demic Press, Inc., 1Q72. New York, The Macmillan Co., 1951. Blohm, H.: Poisonous Plants ot Venezuela, Cambridge, North, P.M.: I 'oiso,uau s Plants and In figi, London, Harvard Universit y Press, 1962. Blandford Press, 1967. Brady, L., and Catalfomo, P. Mushroom Toxicity and O'Leary, SB.: Poisoning in Man from Eating Poison- Wal- Medical Treatment. In Mushrooms and Man. ous Plants, Arch. Environ. Health, 9(8):216, 1964. ed., Albany, Oregon, Linn-Benton Com- ters, r., Rumack, OH., and Salzman, F., eds.: Mushroom Pot- munity College, 1977. swiuii,ç: Diagnosis and Treat'm'uit. West Palm Beach, Christensen, WI. Milk Sickness: A Review of the Florida, CRC Press, Inc., 1978. , 19(3):293, 1965. Literature, Econ. Botan y Schwcirting, A.E.: Poisonous Plants. In Toxicology. Der Marderosian, A.: Poisonous Plants In and Mechanisni q and Methods, Vol. II, Stewart, C.P., Around the Home, Am. I. Pharm. Ed., 30(1):115, and Stolman, A., eds., New York, Academic 1966. Press, Inc., 1961. 9th ed., Los Dreishach, RH.: Handbook of Poisoning, Schwaiting, A.E. Poisonous Seeds and Fruits, I'rog. Altos, Lange Medical Publications, 1977. Chem. Toxicol., 1:385, 1963. Australia, Sydney, Everist, S.L.: Poisono?ts Plants of Smith, A .H.: Mushroonis in Their Natural Habitats, Port- Australia, Angus and Robertson (Publishers) Pty land, Oregon, Sawyer's Inc., 1949. Ltd., 1974, Smith, AFT.: Tin- Mushrooiui limiter's Field Guide, rev. Evers, R.A., and Link, RI'.: Poisonous Plants of the ed., Ann Arbor, University of Michigan Press, Midwest and Their Effects on Livestock, Special Pub!. 1971. 24, Urbana-Champaign. Universit y of Illinois, l'vler, V. Jr.: Poisonous Mushrooms, Prog. Chem. 1972. Toxicol., 1:339, 1963. Fochtmart, F.W., Marine, J.E., Winek, CL., and Walter, W. C.: Dieffenbachia Toxicity, )AMA, 201:(2)154, Cooper, J.A.: 'toxicity of the Genus Dieffrithachia. 1967. Toxicol. Appi. Pharmacol., 15(0:38, 1969. Watt, J.M.. and Breyer-Brandwijk, MG.: The Medic- Francis, OF., and Southcott, R.V.: Plants harmful to inal and Poisonous Plants of Southern and Eastern Man in Atmst u's/ia, Adelaide, Botanic Garden, 1967. Africa, Edinburgh, E. & S. Livingstone, Ltd., 1962. Frrihn, 0.. and P1nder, H.J.: A Colour Atlas of Poi- Wieland, 1'., and Wieland. 0.: The Toxic Peptides of sonous Plants, London, Wolfe Publishing Ltd., Anmoita Epcies. In Microbial Toxins, Vol. Viii, 1984, IZ,adis, S.A., Ciegler, A.. and AjI. SI., eds., New Hardin, JAN., and Arena, J . M,: Hn,u'an, .nj York, Academic Pcss, inc., i972. Notice and Cu!tit'iuhd Piu:es. i'i emi . Durham Youngken, H .W., Jr, and Karas, j.S.: Common Poison - North Cai'oiica, Duke Urversitv Press, 1974. on;ous Plauits of New England, W 1 gtc. D.C., U.S. Hatfield. G.M.. - d brady, L.R.: Toxins of Higher Department of flc;th, Education and Welfare. iui, Llovdia, 38(1):36, 1975. Public 1le.iiu Service Publication u, 1220. !964.