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Plant Poisoning

Plant Poisoning. Dr. Ravi Nanayakkara . Objectives. Introduction, classification and identification of poisonous plants. Circumstances, route of entry, metabolism and excretion of plant poisons.

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Plant Poisoning

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  1. Plant Poisoning Dr. Ravi Nanayakkara

  2. Objectives • Introduction, classification and identification of poisonous plants. • Circumstances, route of entry, metabolism and excretion of plant poisons. • Mechanism of action, target organs, clinical features(early and late phase) and principles of management. • Autopsy features(external and internal) and sample collection.

  3. Plant poisoning • More than 300 poisonous plants. • Some are edible. • Act on more than one organ, but act principally on one organ system.

  4. Classification • Neurotoxins • Cardiac toxins • Gastrointestinal irritants • Cellular poisons

  5. Neurotoxins • Datura stramonium • Substances of abuse Canabis sativa Erythrocylon coca Papaver somniferum • Strychnos Nux vomika

  6. Cardiac toxins • Nerium odorum • Thevetia peruviana

  7. Gastro intestinal irritants • Gloria superba • Ricinus communis

  8. Cellular poisons • Manihot utilissma • Adenia palmeta

  9. Datura stramonium • Attana • CNS

  10. Toxic substances • Atropine • Hyoscine • Hyocyamine • Scopolamine All are alkaloids

  11. Circumstances • Accidental –Children eat the seed or fruit Eating the leaves (mistakenly) • Intentional – for revenge, confuse an enemy to robbery – mix with thalaguli during long distance bus travels • Suicidal ingestion rare.

  12. Absorption • GIT • Skin • Mucous membranes

  13. Target Organs - Atropine • brain, heart, smooth muscles, glands • Excretion - Kidney

  14. Clinical features • Shown in the table.

  15. Principles of Management • Eliminate the poison • Phytostigmine to reverse the action • Diazepam to control fits • Manage complications accordingly

  16. Mode of death • Respiratory paralysis  Asphyxia

  17. Postmortem finding • Non specific • Seeds or fragments of the plant may be found in the stomach.stomach may show slight inflmmation. • Lungs : pulmonary oedema. • Other organs will show sings of asphyxia.

  18. Specimen collection • Stomach and contents • Intestine • Urine • Blood

  19. Canabis sativa • Ganja – flower • Marijuana – flowery tops / cut leaves • Hashish – dried resin • H oil – oily extract

  20. Toxic substances • Alkaloids • Cannabinol • Cannabidiol • Cannabidiolic acid

  21. Circumstances • Smoking • Beverage • With datura

  22. Clinical features • Inhibitions removed – like alcohol • Confusion • Restlessness • Hallucinations • Narcosis • Nausea • Depression

  23. Principles of management • Symptomatic

  24. Autopsy • Non specific • Features of addiction

  25. Erythrocylon coca • Grows in Central/South America • Toxic Substances • Alkaloid – cocaine • Leaves • Synthetic • Action – stimulates CNS and CVS similarly to adrenalin

  26. Clinical features Shown in the table.

  27. Discussed in drugs of abuse

  28. Papaver somniferum(Opium / Heroin) • Unriped capsule of poppy plant • Alkaloids – morphine codeine narcolin papavarin ……

  29. Circumstances • Ingestion • Inhalation • Injections

  30. Clinical features • Excitement – euphoria • Depression of brain stem • Narcosis and death

  31. Discussed in drugs of abuse

  32. Strychnos Nux vomikaGoda/Divi kaduru • Spinal stimulant • Commonly found in Southern costal area. • Toxin is mainly found in seeds. • Poison – Strychnine ( an alkaloid)

  33. Circumstances • Accidental – Children eat fruit • Suicidal rare due to bitter • Homicidal rare due to bitter • Abstract of seeds(strychnine) is used to as a rodenticide, kill stray dogs by injecting with a long stick • Homicidal injection - rare

  34. Absorption • All mucosal surfaces • Rapidly absorbed via GIT and spread throughout body

  35. Target organ • Spinal cord and brain

  36. Action • Strychnine stimulate the brain and spinal cord by inhibiting the inhibitory pathways. • Hyperexcitation of brain stem and spinal cord. • Slightest stimulation can cause convulsions.

  37. Clinical features • Bitter taste in mouth • Muscle stiffness • Tremors • Twitching • Convulsions • Concious till death

  38. Differential diagnosis

  39. Management • Maintain airway, breathing, circulation • Control fits • Minimum stimulation Gastric lavarge and vomiting can precipitate convulsion. • Management of complications

  40. Mode of death • Hypoxia to brain stem Respiratory paralysis Asphyxia

  41. Autopsy • Non specific • Asphyxia • Muscle haemorrhages

  42. Cardio vascular system • Thevetia peruviana – Yellow oliander • Nerium oleander – Pink oliander

  43. Circumstances • Suicide-consume fruits • Accidental – any part of the plant (children) • Homicidal-rare

  44. Toxic substance • Cardiac glycosides – digitalis like action • Inhibit Na+/K+ ATPase • Alteration of membrane potential in myocardium and neurones • Increse cardiac Excitability Contractility Automaticity

  45. Route of absorption • GIT-injestion

  46. Target organs • Heart (mainly) - Arrhythmias • CNS - Neuronal excitability  depression • GIT-irritant

  47. Clinical features • Faintishness,papitation, irregular pulse,hypotensoin • Yellow vision,blurred vision,dilated pupils, muscular twiching,tetanic spasms,anxiety, confusion • Nausea,vomiting • Pain in throat and numbness in tongue and lips,abdominal pain,profuse salivation

  48. Principles of management • Emesis • Activated charcoal • Antidote-Kaneru tab (Antibody against cardiac glycosides) • Management of complications

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