Authors Note

that most of these "exposures" were simply that—exposures. That is, no toxin particular problem when plants are discussed by their common rather than by exposure is generally preferable to managing a patient with an "exposure to an unknown plant," many plant-exposed cases are managed successfully without

Years) in 2003

Arts/crafts/office supplies

Hormones and hormone antagonists

Electrolytes and minerals

22,337

Frequency

Spathiphyllum spp.

Peace lily

Philodendron

Poinsettia

Ilex spp.

Holly

Ficus spp.

Rubber tree, weeping fig

Poison ivy

Dieffenbachia spp.

Dumbcane

Jade plant

Pothos, devil's ivy

Capsicum annuum

Pepper

Rhododendron, azalea

Chrysanthemum

Oleander

Schlumbergera bridgesii

Christmas cactus

English ivy

Eucalyptus spp.

Eucalyptus

Apple, crabapple(plant parts)

703

Heavenly bamboo

Saintpaulia ionantha

African violet

Note: This table provides the frequency of involvement of plants in exposures reported to poison centers.

Note: This table provides the frequency of involvement of plants in exposures reported to poison centers.

algorithms and of books that help in plant identification is always appreciated, although this is unlikely to replace the assistance of a trained professional who is able to correctly identify plants. This person may typically be a professional common plants. A positive identification of an individual plant is most likely is presented to the knowledgeable botanist or horticulturist. Poison Control Centers generally have relationships with the botanical community should the the interaction between the botanical and medical communities is clear and effi-

the exacting demands of a clinical situation.

As most exposures result in little or no toxicity, the initial management of most incidents involving children who are asymptomatic should be expectant. This approach includes observation, at home or in the hospital as appropriate, depending on the nature of the exposure, and supportive care. For example, and oral rehydration or, occasionally, intravenous fluids. Perhaps the greatest paradigm shift since the publication of the earlier edition of this book is the lavage should be reserved for those patients with a reasonable likelihood of patients exposed to plants. Although oral activated charcoal is effective at reduc-

plant exposures has never been specifically studied. However, given the extremely low risk of administration of oral activated charcoal to an awake patient who is able to drink spontaneously, its use should be considered in patients with plant exposures. For complete information on the initial decontamination of the poisoned patient, call your regional Poison Control Center or refer to a textbook of medical toxicology, emergency medicine, or pediatrics.

Sections 2 ("Poisons, Poisoning Syndromes, and Their Clinical Management"), 3 (Plant-Induced Dermatitis [Phytodermatitis]), and 4 (Gastrointesti-

descriptions of management strategies for patients with plant poisonings. Although very few antidotes are available to treat the effects of the innumerable toxins available in plants, rarely are antidotes actually necessary. Much of our tion of "toxin" in the plant than there is of "drug" in a tablet. However, this by containing a consequential toxin, such as Colchicum autumnale, which contains As already suggested, there is little adequate evidence to precisely direct the the wide diversity of available plants and the limited quality of available case ately) of low priority to the physician involved with the care of the exposed patient. As with many other clinical situations, bedside care of patients with ifestations and responses to therapy and only secondarily on the basis of the toxin to which they are presumably exposed. The dictum has been and remains "Treat the patient, not the poison".. .. but don't ignore the poison.

plant identification? Vet Hum Toxicol 1992;34:544-546.

Watson WA, Litovitz TL, Klein-Schwartz W, et al. 2003 Annual report of the American Med 2004;22:335-404.

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