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Toxic plant ingestions and nicotine poisoning in children: Management

Brian A Bates, MD
Section Editor
Michele M Burns, MD, MPH
Deputy Editor
James F Wiley, II, MD, MPH


Children are frequently exposed to potentially toxic plants, both in the home and outdoors. While these exposures rarely result in clinically significant poisoning, it is important for healthcare providers to be aware of the limited number of plants that have the potential to cause serious clinical effects. Most young children are asymptomatic or have minimal gastrointestinal toxicity after exploratory plant ingestions (eg, picking berries off a bush). Serious poisoning is associated with large ingestions of highly toxic plant species (table 1), which typically occurs in the setting of suicidal ingestion, foraging mistakes, or intentional recreational use.

Defining which clinical findings predominate, initiating general supportive care, and administering any specific treatments are the key steps in the initial management for toxic plant ingestions. The management of toxic plant ingestions in children will be reviewed here. Evaluation and clinical manifestations of potentially toxic plant ingestions or poisonous mushrooms, the management of toxic mushroom poisoning, and contact dermatitis caused by poison ivy are discussed separately:

(See "Potentially toxic plant ingestions in children: Clinical manifestations and evaluation".)

(See "Clinical manifestations and evaluation of mushroom poisoning".)

(See "Management of mushroom poisoning".)


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Literature review current through: Sep 2016. | This topic last updated: May 23, 2016.
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  1. Mrvos R, Dean BS, Krenzelok EP. Philodendron/dieffenbachia ingestions: are they a problem? J Toxicol Clin Toxicol 1991; 29:485.
  2. Palmer, M, Betz, JM. Plants. In: Goldfrank’s Toxicologic Emergencies, 9th edition, Nelson LS, Lewin NA, Howland MA, Hoffman RS, Goldfrank LR, Flomenbaum NE (Eds), McGraw-Hill, New York 2011. p.1537.
  3. Cumpston KL, Vogel SN, Leikin JB, Erickson TB. Acute airway compromise after brief exposure to a Dieffenbachia plant. J Emerg Med 2003; 25:391.
  4. Smolinske SC, Daubert GP, Spoerke DG. Poisonous plants. In: Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose, 4th edition, Shannon MW, Borron SW, Burns MJ. (Eds), Saunders Elsevier, Philadelphia 2007. p.473.
  5. Gunduz A, Turedi S, Russell RM, Ayaz FA. Clinical review of grayanotoxin/mad honey poisoning past and present. Clin Toxicol (Phila) 2008; 46:437.
  6. Festa M, Andreetto B, Ballaris MA, et al. [A case of Veratrum poisoning]. Minerva Anestesiol 1996; 62:195.
  7. Froberg B, Ibrahim D, Furbee RB. Plant poisoning. Emerg Med Clin North Am 2007; 25:375.
  8. Tekol Y, Kameyama M. [Electrophysiology of the mechanisms of action of the yew toxin, taxine, on the heart]. Arzneimittelforschung 1987; 37:428.
  9. Tai YT, But PP, Young K, Lau CP. Cardiotoxicity after accidental herb-induced aconite poisoning. Lancet 1992; 340:1254.
  10. Pierog J, Kane B, Kane K, Donovan JW. Management of isolated yew berry toxicity with sodium bicarbonate: a case report in treatment efficacy. J Med Toxicol 2009; 5:84.
  11. Adaniya H, Hayami H, Hiraoka M, Sawanobori T. Effects of magnesium on polymorphic ventricular tachycardias induced by aconitine. J Cardiovasc Pharmacol 1994; 24:721.
  12. Gottignies P, El Hor T, Tameze JK, et al. Successful treatment of monkshood (aconite napel) poisoning with magnesium sulfate. Am J Emerg Med 2009; 27:755.e1.
  13. Panzeri C, Bacis G, Ferri F, et al. Extracorporeal life support in a severe Taxus baccata poisoning. Clin Toxicol (Phila) 2010; 48:463.
  14. Connolly GN, Richter P, Aleguas A Jr, et al. Unintentional child poisonings through ingestion of conventional and novel tobacco products. Pediatrics 2010; 125:896.
  15. Solarino B, Rosenbaum F, Riesselmann B, et al. Death due to ingestion of nicotine-containing solution: case report and review of the literature. Forensic Sci Int 2010; 195:e19.
  16. Centers for Disease Control and Prevention (CDC). Ingestion of cigarettes and cigarette butts by children--Rhode Island, January 1994-July 1996 . MMWR Morb Mortal Wkly Rep 1997; 46:125.
  17. Smolinske SC, Spoerke DG, Spiller SK, et al. Cigarette and nicotine chewing gum toxicity in children. Hum Toxicol 1988; 7:27.
  18. Kamboj A, Spiller HA, Casavant MJ, et al. Pediatric Exposure to E-Cigarettes, Nicotine, and Tobacco Products in the United States. Pediatrics 2016; 137.
  19. Woolf A, Burkhart K, Caraccio T, Litovitz T. Childhood poisoning involving transdermal nicotine patches. Pediatrics 1997; 99:E4.
  20. Riou B, Kongolo G, Djeddi D. [Nicotine poisoning from patch application: a pediatric case report]. Arch Pediatr 2015; 22:895.
  21. Schep LJ, Slaughter RJ, Beasley DM. Nicotinic plant poisoning. Clin Toxicol (Phila) 2009; 47:771.
  22. McBride JS, Altman DG, Klein M, White W. Green tobacco sickness. Tob Control 1998; 7:294.
  23. McKnight RH, Spiller HA. Green tobacco sickness in children and adolescents. Public Health Rep 2005; 120:602.
  24. Chatham-Stephens K, Law R, Taylor E, et al. Notes from the field: calls to poison centers for exposures to electronic cigarettes--United States, September 2010-February 2014. MMWR Morb Mortal Wkly Rep 2014; 63:292.
  25. Vakkalanka JP, Hardison LS Jr, Holstege CP. Epidemiological trends in electronic cigarette exposures reported to U.S. Poison Centers. Clin Toxicol (Phila) 2014; 52:542.
  26. Cantrell FL, Clark RF. More on nicotine poisoning in infants. N Engl J Med 2014; 371:880.
  27. Bassett RA, Osterhoudt K, Brabazon T. Nicotine poisoning in an infant. N Engl J Med 2014; 370:2249.
  28. Upstate New York boy, 1, dies after ingestion liquid nicotine. New York Daily News. Monday, December 15, 2014. http://www.nydailynews.com/news/national/1-year-old-n-y-boy-dies-ingesting-liquid-nicotine-article-1.2045532 (Accessed on December 16, 2014).
  29. Centers for Disease Control and Prevention (CDC). Notes from the field: electronic cigarette use among middle and high school students - United States, 2011-2012. MMWR Morb Mortal Wkly Rep 2013; 62:729.
  30. Chen BC, Bright SB, Trivedi AR, Valento M. Death following intentional ingestion of e-liquid. Clin Toxicol (Phila) 2015; 53:914.
  31. Swinker M, Meredith JT. A seizure in the tobacco field. Green tobacco sickness. N C Med J 2000; 61:390.
  32. Ballard T, Ehlers J, Freund E, et al. Green tobacco sickness: occupational nicotine poisoning in tobacco workers. Arch Environ Health 1995; 50:384.
  33. West PL, Horowitz BZ, Montanaro MT, Lindsay JN. Poison hemlock-induced respiratory failure in a toddler. Pediatr Emerg Care 2009; 25:761.
  34. Barceloux DG. Akee fruit and Jamaican vomiting sickness (Blighia sapida Köenig). Dis Mon 2009; 55:318.
  35. From the Centers for Disease Control and Prevention. Water hemlock poisoning--Maine, 1992. JAMA 1994; 271:1475.
  36. Wax PM, Cobaugh DJ, Lawrence RA. Should home ipecac-induced emesis be routinely recommended in the management of toxic berry ingestions? Vet Hum Toxicol 1999; 41:394.
  37. Eddleston M, Juszczak E, Buckley NA, et al. Multiple-dose activated charcoal in acute self-poisoning: a randomised controlled trial. Lancet 2008; 371:579.
  38. de Silva HA, Fonseka MM, Pathmeswaran A, et al. Multiple-dose activated charcoal for treatment of yellow oleander poisoning: a single-blind, randomised, placebo-controlled trial. Lancet 2003; 361:1935.
  39. Amlo H, Haugeng KL, Wickstrøm E, et al. [Poisoning with Jimson weed. Five cases treated with physostigmine]. Tidsskr Nor Laegeforen 1997; 117:2610.
  40. Glatstein MM, Alabdulrazzaq F, Garcia-Bournissen F, Scolnik D. Use of physostigmine for hallucinogenic plant poisoning in a teenager: case report and review of the literature. Am J Ther 2012; 19:384.
  41. Krenzelok EP, Jacobsen TD, Aronis J. Is the yew really poisonous to you? J Toxicol Clin Toxicol 1998; 36:219.
  42. Bandara V, Weinstein SA, White J, Eddleston M. A review of the natural history, toxinology, diagnosis and clinical management of Nerium oleander (common oleander) and Thevetia peruviana (yellow oleander) poisoning. Toxicon 2010; 56:273.
  43. Eddleston M, Rajapakse S, Jayalath S, et al. Anti-digoxin Fab fragments in cardiotoxicity induced by ingestion of yellow oleander: a randomised controlled trial. Lancet 2000; 355:967.
  44. Camphausen C, Haas NA, Mattke AC. Successful treatment of oleander intoxication (cardiac glycosides) with digoxin-specific Fab antibody fragments in a 7-year-old child: case report and review of literature. Z Kardiol 2005; 94:817.
  45. Barrueto F Jr, Jortani SA, Valdes R Jr, et al. Cardioactive steroid poisoning from an herbal cleansing preparation. Ann Emerg Med 2003; 41:396.
  46. Safadi R, Levy I, Amitai Y, Caraco Y. Beneficial effect of digoxin-specific Fab antibody fragments in oleander intoxication. Arch Intern Med 1995; 155:2121.
  47. Rich SA, Libera JM, Locke RJ. Treatment of foxglove extract poisoning with digoxin-specific Fab fragments. Ann Emerg Med 1993; 22:1904.