Case history
Case history #1
A 17-year-old man presents to the emergency department, accompanied by his mother, with agitation and confusion. His mother says she found him with a paper bag containing large white flowers with spiked round fruits filled with black seeds. He has no known medical problems and does not take any medication. On exam the patient is alert, but disoriented and restless; he is picking at invisible objects. He is tachycardic and flushed, and has a slight fever, 6 mm minimally responsive pupils, and dry mucous membranes. His abdomen is nontender with decreased bowel sounds, and there are no focal neurologic deficits. He is unable to urinate and catheterization releases 900 mL urine.
Case history #2
A 3-year-old girl is brought to the emergency department with tummy ache on Christmas day. She points to her epigastric area as the location of the pain. Her mother denies fever, cough, diarrhea, rash, or sick contacts. She has no past medical history and takes no medication. On exam the patient is afebrile and her vital signs are normal. There are no exam findings to note, except slight erythema (without swelling) on her tongue. Her abdomen is soft and nontender with normal bowel sounds. While in the emergency room, the patient vomits several pieces of red and green strips of plant or vegetable material. She says "It's a pretty flower at the fireplace." The mother calls home and the father reports that the decorative poinsettia is missing many leaves.
Other presentations
Unusual plant poisonings may cause intractable seizures, acidosis, liver necrosis, heart block with hypotension, or tachycardia with hypertension.
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