-IBIS-1.5.0-
rx
toxidrome
Alkaloid toxidrome
botanicals
definition
alkaloid 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:
» Aconitum napellus
» Baptisia tinctoria
» Chondodendron tomentosum
» Colchicum autumnale
» Conium maculatum
» Cytisus scoparius
» Delphinium staphysagria
» Polygonatum multiflorum, Polygonatum officinale
» Aconitum napellus:
treatment for overdose: body warming (internally and externally), administration of atropine 0.05 mg/kg body weight, 2 - 3 mg total dose, and a potassium permanganate (1:1000) gastric lavage (Levy and Primack, p. 120; Theines and Haley, p. 24; Cooper, et al; Turnball)
Internal use may result in immediate oral burning, tingling, numbness, and throat constriction; followed by salivation, gastritis, nausea and vomiting. Characteristic tingling may spread over the entire body surface. Dysarthria, ataxia, vertigo, blurred vision, paresthesias and general weakness can follow. Myotoxic effects include stimulation followed by depression of cardiac, smooth and skeletal muscle. Alkaloidal effects on CNS and peripheral nerves produce a curare-like paralysis with labored respirations spreading from upper extremities to lower. Death from cardiac arrhythmia and respiratory failure occurs within 1-8 hours. (A.M.A., p. 20; Dreisbach, p. 434; Levy and Primack, p. 120; Theines and Haley, p. 24)
laboratory changes: hypocalcemia due to reduction in free Ca++ ions
» Baptisia tinctoria:
gastrointestinal toxidrome due to alkaloids: nausea and diaphoresis. Toxic in large doses; acts as an emetocathartic, causing gastroenteritis, profuse salivation, ulceration, insomnia, restlessness, ocular disturbances, overall muscular soreness; respiratory paralysis may occur resulting in death (Felter and Lloyd, p. 225)
» Chondodendron tomentosum:
treatment for overdose: administration of Physostigma with Atropa, Datura, or Hyoscyamus; maintain respiration and provide adequate oxygenation; recuperation requires at least an hour (Cain, p. 461; Simpson and Curtis, pp. 99 - 156)
Curare intoxication affects skeletal muscles, autonomic nervous system, and the central nervous system; it may also produce a histamine-like reaction.
effects upon skeletal muscles: weakness progressing to atony and finally flaccid paralysis; effects spreading from eyes and ears to the neck, limbs, trunk, intercostal muscles, and finally to the diaphragm; with overdose, strabismus and diplopia develop in minutes followed by palpebral ptosis, dysarthria, dysphasia, and paralysis; respiratory paralysis can occur in less than five minutes
autonomic effects: hypotension, tachycardia, vascular collapse, and bradycardia
CNS effects: vertigo, sensation of warmth and heavy limbs, dysphasia, blurred vision
histamine-releasing action: sudden hypotension, shock and death can occur; bronchospasm may be noted. Slower reactions include wheals, swelling of the limbs, vasodilation and increased gastric secretions (Simpson and Curtis, pp. 99 - 156)
general references: Cooper et al; McIntyre, Schultes and Hoffman; Simpson and Curtis
» Colchicum autumnale:
A delayed onset of the toxic reaction is known to occur; two to six hours after intake the patient begins to experience oral mucosal burning, vesiculation with dysphagia and intense thirst. This is followed by gastrointestinal toxidrome: nausea, vomiting, diarrhea, colic and severe abdominal pain. Profuse vomiting and diarrhea lead to potentially fatal hypovolemic shock, with kidney damage, hematuria, and finally oliguria and anuria (Fuller and McClintock, p. 281). Malabsorption syndromes, alopecia, hepatitis, peripheral neuritis, and myopathy may ensue (Brinker, p. 33)
Severe intoxication can occur due to the purified Colchicum-derived colchicine.
The signs and symptoms closely resemble those associated with cholera (von Oettingen, pp. 120, 131, 310)
laboratory test results: shadow cells with Heinz bodies; chronic use results in thrombocytopenia, pancytopenia, and leukopenia; also hemoglobinuria, porphyrinuria, coproporphyrinuria, and proteinuria have been noted, especially in leukemic patients (von Oettingen, p. 310; Brinker, p. 33)
» Conium maculatum:
treatment for overdose: rehydration, keeping airway clear; use artificial respiration if necessary; anticonvulsant therapy may be needed; antidotes: picrotoxin, Strychnine, lemon juice with vinegar (Duke, pp. 139 - 140)
Coniine produces severe neurotoxic signs and symptoms: in the first thirty to sixty minutes the patient experiences salivation, nausea, vomiting, and pharyngeal irritation. Mydriasis always occurs, often with double vision. These symptoms are followed by vertigo, dry mouth, headache, thirst, dysphagia. Ocular effects include dilated pupils, diplopia, and amblyopia. In severe cases the patient will experience convulsions, and weak or paralyzed muscles ascending upwards from the lower extremities and affecting the trunk and respiratory muscles. There is no loss of consciousness until right before death which occurs due to central and peripheral nervous system paralysis (Cain, p. 458; Felter and Lloyd, p. 543, Theines and Haley, p. 28; von Oettingen, p. 311)
» Cytisus scoparius:
gastrointestinal irritant with oro-esophageal burning; also causes dyspnea, headache, myalgia, ataxia, muscle fasciculations and cramps, hypotension, skin may become pale and clammy; cardiac changes include slow, weak, and irregular contractions with depressed conductivity as shown by EKG; neurological signs include vertigo, somnolence, delirium, hallucinations; occasionally oliguria or anuria (Theines and Haley, p. 25, von Oettingen, p. 321)
symptoms of muscular paralysis due to change in Ca++ ion concentrations; the alkaloids can also cause dyspnea, Cheyne-Stokes respirations and respiratory paralysis; cardiac and/or respiratory collapse can occur in a few minutes or in eight to ten hours (Cain, p. 462;Theines and Haley, p. 24; von Oettingen, p. 321)
laboratory test results: oliguria, anuria, uremia
» Delphinium staphysagria:
treatment of overdose: body warming (internally and externally), administration of atropine 0.05 mg/kg body weight, 2 - 3 mg total dose, and a potassium permanganate (1:1000) gastric lavage (Levy and Primack, p. 120; Theines and Haley, p. 24; Cooper, et al; Turnball)
Ingestion can lead to a burning sensation, dryness of the mouth, stiffness of facial muscles, nausea, eructations, and involuntary urination and defecation. Systemic spread of the toxins results in pruritus, burning throughout; tinnitus, followed by somnolence and unconsciousness then occur. Severe cases will consist of hypotension, circulatory collapse and labored respirations leading to cyanosis and death (Turnball; von Oettingen, p. 324).
Curare-like effects have been noted (Simpson and Curtis, pp. 104 - 105)
footnotes
Brinker F. 1996. The Toxicology of Botanical Medicines, rev. 2nd ed., Sandy, Oregon: Eclectic Medical Publications.
Cain, H.D. 1980. Flint's Emergency Treatment and Management, 6th ed. Philadelphia: W.B. Saunders Company.
Cooper, J.R., Bloom, F.E., Roth, R.H. 1986. The Biochemical Basis of Pharmacology, 5th ed. New York: Oxford University Press.
Dreisbach, R.H. 1980. Handbook of Poisoning: Prevention, Diagnosis, and Treatment, 10 ed. Grand Rapids, MI: Lange Medical Publications.
Duke, J.A. 1985. C.R.C. Handbook of Medicinal Herbs. Boca Raton, FL: The C.R.C. Press.
Felter, H. W., and Lloyd, J. U. 1983. King's American Dispensatory, Vols. I and II. Portland, OR: Eclectic Medical Publications.
Fuller, T.C., and McClintock, E. 1986. Poisonous Plants of California. Los Angeles: University of Southern California Press.
Lampe, K.F., and McAnn, M.A. 1985. AMA Handbook of Poisonous and Injurious Plants. Chicago: American Medical Association.
Levy, C.K.; and Primack, R.B. 1984. A Field Guide to Poisonous Plants and Mushrooms of North America. The Stephen Green Press.
McIntyre, A.R. 1947. Curare: Its History, Nature, and Clinical Use. Chicago, IL: The University of Chicago Press.
Schultes, R.E., Hoffmann, A. 1973. The Botany of Hallucinogens. Springfield, IL: Charles C. Thomas.
Simpson, L.L., Curtis, D.R. 1977. Neuropoisons; Their Pathophysiological Actions. New York: Plenum Press.
Thienes, C.H., Haley, T.J. 1975. Clinical Toxicology. 5th ed. Philadelphia: Lea and Febiger.
Turnball, A. 1838. On the Medical Properties of the Natural Order Ranunculaceae. Philadelphia: Haswell, Barrington and Haswell.
von Oettingen, W.F. 1958. Poisoning: A Guide to Clinical Diagnosis and Treatment. Philadelphia: W.B. Saunders and Company.