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toxidrome

Oxalate toxidrome

botanicals

definition

oxalate toxidrome

the following toxicity information is largely derived from poisonings, overdoses and research on isolated constituents; used with appropriate clinical judgment and cautious prescribing, herbs are safe and efficacious

plants included:

» Rheum spp.

» Rumex crispus

overdose treatment includes calcium supplements, e.g. calcium citrate or carbonate, dark leafy greens, dairy products; limewater or dilute potassium permanganate binds the oxalate remaining in the stomach; emesis (Duke, p. 404; Theines and Haley, pp. 243-244)

• Oxalate toxidrome: immediate chemical irritation may occur; this caustic effect decreases with time. A marked erythema of the oral mucosa may be seen upon physical examination. One day following overdose, systemic effects occur including: nausea, vomiting, and diarrhea. Blood loss may occur due to intestinal bleeding, epistaxis, and tissue damage following the formation of oxalate crystals interstitially. Reduced calcium levels result in changes of contractility in muscular tissues, especially the myocardium. Watch for skeletal muscle effects including cramps, fasciculations, convulsion-like activity, and headache. Effects on the nervous system include headache, confusion, hyperirritability, clonic convulsions, coma and rarely death. Anthocyanins and calcium oxalate crystal formation may lead to jaundice and kidney failure with hematuria and pain. Chronic intake may result in the formation of large calcium oxalate stones (Levy and Primack, pp. 71; Theines and Haley, pp. 234-244).

laboratory test results: hypocalcemia, electrolyte imbalances, oliguria to anuria (flow decreasing due to severe renal damage); albuminuria, hematuria, proteinuria, and oxaluria with calcium oxalate crystals (Levy and Primack, p. 71; von Oettingen, pp. 124-134; Theines and Haley, pp. 243-244); a decrease in prothrombin time has been noted (Tedeschi et al, p. 1524)

footnotes

Duke, J.A. 1985. C.R.C. Handbook of Medicinal Herbs. Boca Raton, FL: The C.R.C. Press.

Levy, C.K.; and Primack, R.B. 1984. A Field Guide to Poisonous Plants and Mushrooms of North America. The Stephen Green Press.

Tedeschi, G.E., et al. 1977. Forensic Medicine: A Study in Trauma and Environmental hazards. Philadelphia: W.B. Saunders Company.

Thienes, C.H., Haley, T.J. 1975. Clinical Toxicology. 5th ed. Philadelphia: Lea and Febiger.

von Oettingen, W.F. 1958. Poisoning: A Guide to Clinical Diagnosis and Treatment. Philadelphia: W.B. Saunders and Company.