Prognosis
The majority of toxic plant ingestions are clinically inconsequential, with complete resolution of symptoms and no substantial sequelae. Between 1983 and 2014, there were 62 plant-related fatalities reported to national poison centers in the US.[3] AAPCC: annual data reports Opens in new window Plant poisoning deaths are likely to be more common in Asia and Africa, but mortality data are not collected in annual poisoning reports, as is the case in the US. A retrospective study in Thailand carried out between 2001 and 2010 identified a total of 2901 poisonous plant exposure cases, with a 0.9% mortality rate.[50] In this study, ingestion of cassava (Manihot esculenta) was the cause of most plant-related fatalities.
More seriously poisoned patients tend to have worse prognoses and more intensive management. With the exception of pokeweed, the more lethal plants are also the most uncommon and include water hemlock, Datura, monkshood, autumn crocus, and oleander. Reported exposures to these plants are rare. Although castor bean (contains ricin; Ricinus communis) and rosary pea (contains abrin; Abrus precatorius) are considered very toxic, no deaths have been described in more than 10 years of reporting. Toxic plant ingestion rarely results in death, and in the US plant exposures do not appear in the top 20 substances involved in human poisonings.
AAPCC: annual data reports
Opens in new window[Figure caption and citation for the preceding image starts]: OleanderFrom private collection of Gerald O'Malley [Citation ends].
[Figure caption and citation for the preceding image starts]: Castor beanFrom private collection of Gerald O'Malley [Citation ends].
Plant poisonings with cardiac consequences
With appropriate supportive care, digoxin immune Fab (digoxin-specific antibody fragments), atropine, vasopressors, antidysrhythmics, and sodium bicarbonate when appropriate, most patients should recover. Aconitine exposures have an in-hospital mortality rate of about 5%. Aggressive treatment of arrhythmias and cardiogenic shock is essential.[12]
Plant poisonings with neurologic consequences
With appropriate supportive care and aggressive seizure control and patient cooling, most patients should recover.
Plant poisonings with gastrointestinal consequences
With adequate supportive care, including intravenous fluids, antiemetics, and acid-reducing agents such as H2 antagonists or proton pump inhibitors, most patients should recover.
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