Poisoning by poisonous plants is an acute or chronic intoxication caused by poisons contained in herbs, flowers, parts of bushes, trees. Clinical symptoms vary depending on the type of plant. Poisoning can occur with a predominance of cholinolytic or nicotine-like syndrome, signs of damage to the heart, kidneys, liver, skin, digestive system. It is diagnosed on the basis of toxicochemical analysis of blood and urine, clinical picture and anamnesis. Methods of treatment: antidote therapy, detoxification measures, maintenance of vital functions of the body.
X49 Accidental poisoning and exposure to other and unspecified chemical and toxic substances
Intoxication with natural poisons accounts for about 2-5% of the total number of acute poisoning. The toxicity of some plant xenobiotics is higher than synthetic ones. For example, the lethal dose of potassium cyanide is 10 mg / kg of weight, muscarine present in fly agarics is 1.1 mg/ kg. Plants can contain several types of toxic substances: curare, atropine, nicotine, strychnine, palitokine, ricin, phalloidin. The most dangerous representatives of the flora are datura, henbane, hemlock, milkweed, poisonous nightshade, wolf’s bast, buttercup, hellebore.
Poisoning with poisonous plants usually occurs with the oral use of toxic herbs or tactile contact with dermatotropic poisons. Risk group: children, people using traditional medicine recipes, employees of pharmaceutical enterprises. Possible reasons include:
- Accidental use of poisonous plants. Residents of cities who come to rest in the countryside are more likely to suffer. They do not have the necessary knowledge and are not able to differentiate dangerous plants (milkweed, wolf’s bast) from harmless ones. Intoxication can also develop with the illiterate use of alternative medicine.
- Deliberate poisoning. Toxic plants can be used to kill a person or neutralize him. In the Middle Ages, natural poisons were actively used during palace coups. Extracts from aconite, hemlock, hemlock were used. Today, such cases are rare, as more effective synthetic damaging compounds have been developed.
- Treatment of alcoholism by a puppeteer. When used simultaneously with alcohol, the plant causes a disulfiram-like effect. If the therapy is carried out secretly, a person may die because he does not realize the existing danger. The cause of death is endogenous poisoning with ethanol metabolites with the development of acute cardiovascular insufficiency.
- The use of products with an admixture of poisonous herbs. Occurs when trying to improve the taste of a dish with the help of self-collected plants, if a person does not have sufficient knowledge in the field of herbology. The number of such cases does not exceed 0.5-1% of all natural exotoxicoses.
- Skin contact with plant juice. Usually causes local signs of damage. The most common burns caused by borscht juice. They appear only under the influence of sunlight. At night, the plant is safe. With massive injuries, the death of the victim from intoxication and multiple organ failure is possible.
The pathogenesis directly depends on the type of plant and the poison contained in it. When poisoning with belladonna and henbane, signs of cholinolytic syndrome come to the fore. The release of acetylcholine and the conduction of nerve impulses in synapses are disrupted. The nicotine-like effect of hemlock, horsetail and venomous milestone leads to the blocking of nicotine receptors of the body, which is accompanied by a deterioration in coordination, hypersalivation, mental changes.
Cardiac glycosides contained in digitalis, goritsvet, lily of the valley, lead to disorders of the coronary rhythm. The action of some enzymes on the membranes of cardiomyocytes is inhibited, sodium ions accumulate in them, and the amount of intracellular potassium decreases. Heliotrope and krestovnik have a hepatotoxic effect. They provoke a violation of liver function, the development of diffuse changes in the parenchyma. Aconite has a complex effect on the central nervous system and the heart, and hellebore has a complex effect on the heart and gastrointestinal tract.
Poisoning with poisonous plants is divided by reasons (domestic, suicidal, criminal), by severity (light, medium, severe and extremely severe), by the toxicity of the plant itself (highly toxic, medium toxic, slightly toxic). It should be borne in mind that the poisoning ability of herbs varies depending on the time of year and what part of it was consumed. The most common classification is based on the ability of flora to affect a particular system of the body:
- With a leading CNS lesion. Representatives: henbane, datura, krasavka, venomous milestone, horsetail. They contain atropine, scopolamine, hyoscyamine. The victim develops a cholinolytic or nicotine-like syndrome. Death occurs from paralysis of the respiratory center and the corresponding muscle groups. The share of such intoxications accounts for about 23% of cases.
- Cardiotropic plants. Representatives: lily of the valley, foxglove, mountain flower, wintergreen. They contain glycosides that can affect the functioning of the cardiovascular system. In small doses they are used as medicines, in large doses they have a toxic effect. The number of poisoning by cardiotropic plants in the general structure does not exceed 3-4%.
- Herbs that cause liver damage. Representatives: cross, pubescent heliotrope, pink mustard, comfrey. The composition includes cynoglossin, lasiocarpine or heliotropin — substances that have a hepatotoxic effect. The number of exotoxicoses by these plants is 2-3%.
- Mainly dermatotropic effects. Representatives: pungent buttercup, hogweed, wolf’s bast. They contain active substances that can cause photo-contact dermatitis, chemical burns. The number of such injuries reaches 18-20%, of which about 5-6% ends fatally. Death occurs when more than 30-40% of the body is damaged.
- Mixed defeats. Representatives: Lobel’s hellebore, bitter nightshade, aconite. These herbs contain a complex of active components that can affect several body systems at once. Most often, the heart and central nervous system are involved in the process; vascular apparatus and gastrointestinal tract, skin and excretion systems.
Poisoning by neurotoxic plants
The clinical picture of intoxication with plant poisons varies widely. The use of neurotoxic substances leads to delirium, psychomotor agitation, hallucinations, headache. Later, depression of consciousness, sopor, coma develops. In addition to the immediate signs of central nervous system damage, the patient shows vomiting, nausea, hoarseness of voice, tachycardia, dry mucous membranes. The duration of the latency period depends on the dose of the toxicant and its route of entry, can range from 10 minutes to 10-15 hours.
Poisoning with cardiotoxic plants
The main symptoms when taking cardiotropic plants: arrhythmia, tachycardia, ventricular extrasystole. Patients complain of a feeling of interruptions in the work of the heart, a feeling of compression in the chest. In addition, there may be abdominalgia, vomiting, flashing of flies before the eyes. If poisoning with poisonous plants is chronic, neuritis develops, manic-depressive psychosis. There is a risk of complete atrioventricular block, cardiac arrest.
Poisoning by hepatotoxic plants
The hepatotoxic effect of herbs leads to the appearance of jaundice, ataxia, vascular asterisks on the skin. The phenomena of dyspepsia are determined. The abdomen is swollen, the discharge of gases is disrupted. Feces acquire a light gray shade, which indicates a deterioration in the outflow of bile. Toxic hepatitis, which develops as a result of poisoning, is often combined with kidney damage. The amount of daily urine decreases in the victim, urea and creatinine indicators increase.
Defeat by dermatotropic plants
Getting the juice of burning plants on the skin is accompanied by the appearance of erythema, blisters filled with serous contents. Systemic and local allergic reactions are possible. With a small size of the lesion, there is no threat to life. Massive injuries are manifested by symptoms of multiple organ failure and intoxication. Poisoning with mixed-action poisons provokes a picture that includes symptoms of exotoxicosis belonging to different groups.
A common complication of lesions with neurotoxic poisons is considered to be a violation of the respiratory structures of the brain and paralysis of the respiratory muscles. Develops in 10-15% of victims, in the absence of medical care ends fatally. Cardiotropic poisons lead to conduction blockade of I-II degree in 45% of patients, III degree – in 3-5%. Liver damage is accompanied by the formation of DIC syndrome, internal bleeding, multiple organ failure.
Chemical burns caused by vegetable juice can become infected. At the same time, there is a risk of sepsis, infectious and toxic shock. Toxic substances released into the blood during the disintegration of necrotic tissues can disrupt the work of excretion systems. This pathology occurs in 6-8% of patients. Poisoning with poisonous plants of mixed action is often the cause of acute respiratory and cardiovascular insufficiency, comatose state. Patients who stay on a ventilator for a long time develop pneumonia.
A preliminary diagnosis is made at the pre-hospital stage by emergency medical personnel. It is not always possible to accurately determine the damaging agent, so the conclusion may sound like “poisoning with poisonous plants, unspecified.” The final conclusions are made by a toxicologist in the hospital. Pathology is differentiated with intoxication by mycotoxins, other toxic substances. Diagnostic methods are used:
- Physical examination. In case of respiratory disorders, wheezing, bradypnea, diffuse cyanosis are determined. There may be inappropriate behavior, a weakening of coordination. The skin is pale or bluish, the pupils are narrowed when intoxicated with atropine-like substances. There is a change in vision.
- Functional methods. On the ECG, deformed extraordinary QRS complexes, F fibrillation waves, loss of part of ventricular signals, reduction of the R-R interval. Blood pressure is higher or lower than normal, tachycardia is characteristic.
- Radiation studies. Abdominal ultrasound shows an increase in the size of the liver, diffuse changes in the hepatic and renal parenchyma. On the X-ray of patients who have been on artificial respiratory support for a long time, signs of pulmonary edema can be determined.
- Laboratory tests. Qualitative tests are carried out to determine the presence of a toxicant in the blood or urine. A biochemical analysis is shown, which detects an increase in the activity of liver enzymes. Renal pathology is accompanied by an increase in the amount of creatinine, urea. It is possible to reduce the concentration of blood clotting factors.
If symptoms of intoxication with herbs appear, doctors should be called and first aid should be provided to the victim. If the poison was ingested, it is necessary to perform a non-probe gastric lavage: give 400-500 ml of water to drink, cause vomiting. Repeat the procedure 3-5 times. After contact with skin poisons, the affected area must be washed with plenty of clean water, covered with a cloth to prevent direct sunlight from falling on it.
Poisoning with poisonous plants requires immediate administration of antidotes. When intoxicated with henbane, proserin is injected with datura; digitalis, lily of the valley — lidocaine and other antiarrhythmic drugs. A probe gastric lavage is required, followed by the introduction of intestinal adsorbents. Toxic substances absorbed into the bloodstream are neutralized with sodium thiosulfate, unithiol. In severe pathology, symptomatic correction, infusion therapy is indicated.
Victims with severe and extremely severe lesions are placed in the ICU. There is round-the-clock hardware monitoring of the condition, massive forced diuresis (up to 10 liters per day), strict control of the water balance. If necessary, respiratory support is provided using a ventilator. Complete blockade of intracardiac conduction requires the installation of an external pacemaker. Dopamine and norepinephrine are injected to maintain hemodynamics. In case of cardiac arrest, measures are taken to restore vital activity.
Treatment in a hospital
During inpatient treatment, the patient continues to receive adsorbents and antidotes. Methods of active detoxification (hemosorption or hemodialysis), forced diuresis, saline laxatives or intestinal lavage are used. In order to stop seizures, anticonvulsants are used, psychomotor agitation is eliminated by neuroleptics. Prophylactic administration of antibiotics is indicated. This is especially true for patients who maintain a supine position for a long time.
Prognosis and prevention
The prognosis is favorable in most cases. Poisoning by poisonous plants in 90% of observations passes without consequences. The death of the victim is possible with severe intoxication and lack of specialized care. Delayed complications are rare. This happens if there was multiple organ failure, toxic hepatitis.
Prevention consists in refusing to use unfamiliar plants inside, excluding self-medication with the help of traditional medicine containing dangerous herbs, careful study of information about the plants being collected.