S2 L7-8 Poisonous plants of Sri Lanka

Anna Drew

& Peradeniya University BPharm Batch 2005/6

(8 July 2008)

with slide contribution from: Ruben Thanacoody, www.wikitox.org

Paracelcus 1493-1541

“All substances are poisons; there is none which is not a poison. The right dose differentiates a poison from a remedy.”

Thevetia peruvianaFamily: Apocyanaceae

Sinhala name/s: kaneru

Tamil name/s: manjal alari

English/common name/s: yellow oleander, lucky nut

Plant habitat:• often used for hedging in Sri Lanka • native of Central & S.America but now grown throughout tropical and

subtropical regions

Toxic part of the plant: seed (although all parts toxic)

Lethal dose: kernel of one fruit (or 2 leaves for a child)

Main toxic constituent/s: thevetin A, thevetin B

Constituent type: cardiac glycosides

Mode of action: inhibit sodium-potassium ATPase• increased intracellular sodium and serum potassium• negative chronotropic, positive inotropic effects

Na+/K+ ATPase

3 Na3 Na++

2 K2 K++

Representative Cardiac CellRepresentative Cardiac Cell

NaNa++ channel channelNaNa++ channel channelVoltage dependentVoltage dependentL-typeL-type CaCa2+2+ channel channelVoltage dependentVoltage dependentL-typeL-type CaCa2+2+ channel channel NaNa++/K/K++ ATPase ATPaseNaNa++/K/K++ ATPase ATPase

NaNa++/Ca/Ca2+2+ exchangerexchangerNaNa++/Ca/Ca2+2+

exchangerexchangerSR (Mitochondria)SR (Mitochondria)SR (Mitochondria)SR (Mitochondria)

Heart muscleHeart muscleHeart muscleHeart muscle

KK++ channel(s) channel(s)KK++ channel(s) channel(s)

Na+/Ca2+ Antiporter

Ryanodine receptorRyanodine receptorRyanodine receptorRyanodine receptor

3 Na3 Na++

CaCa2+2+

ββ-adrenergic receptor-adrenergic receptorββ-adrenergic receptor-adrenergic receptor

3 Na3 Na++

2 K2 K++

Cell ElectrophysiologyCell Electrophysiology

SR (Mitochondria)SR (Mitochondria)SR (Mitochondria)SR (Mitochondria)

CaCa2+2+

Phase 2Phase 2

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

3 Na3 Na++

CaCa2+2+

3 [Na3 [Na++]]

2 [K2 [K++]]

Therapeutic & Toxic MoATherapeutic & Toxic MoA

SR (Mitochondria)SR (Mitochondria)SR (Mitochondria)SR (Mitochondria)

CaCa2+2+

Phase 2Phase 2

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

= Digoxin= Digoxin

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

CaCa2+2+

Digoxin

NaNa++

K+K+

Clinical features of poisoning: “digoxin-like”• Early on: burning sensation in mouth, tingling of tongue, dry throat,

giddiness, nausea vomiting, diarrhoea• Cardiovascular: sinus bradycardia, first and second degree heart

block, junctional rhythms, atrial and ventricular extrasystoles, ventricular fibrillation

• Other: yellow vision, anxiety, convulsions, coma

Diagnosis:• cardiac glycoside blood levels • seed remnants, vomitus, gastric aspirate may help identify• monitor serum potassium and electrolytes

Treatment of poisoning:• induce emesis at home (ipecac)• gastric lavage within 1 hour or activated charcoal• atropine 0.5mg IV for bradycardia, repeated• cardiac pacing for third degree heart block• anti-digoxin Fab antibodies in severe cases

References: Lucas GN, De Silva TUN. Poisonous plants of Sri Lanka. Colombo: Sri Lankan College of Paediatricians, 2006; IPCS Inchem. Thevetia peruviana. Dated March 1990 [Accessed at http://www.inchem.org/documents/pims/plant on 29 June 2008]; www.wikitox.org

Datura metel

S.H.T. SUDESHIKA T.A.D. SANJEEWA

Scientific name: Datura metelSynonyms: Datura fastuosa (L.) Datura alba (Nees.) Family: Solanaceae Sinhala name: Ela-attanaTamil name: AyigamCommon names: Devil's trumpet, downy thorn-apple, black datura, angel's trumpet

Plant habitat: Native to China, India and South East Asia.It is a common weed in waste and

cultivated land in Sri-lanka and now it is used in landscaping and gardening .

Plant description: Shrub-like annual herb with large flowers, typically

white or yellow with deep purple accents. Leaves are alternate and simple.

Traditional use: Leaves/dried flowers are used to relieve asthma or wheezing like symptoms in many cultures eg Chinese herbal medicine (yáng jīn huā).

Leaf poultices are applied to engorged breasts to relief excess milk production, rheumatic swelling of joints and lumbago.

Powdered root is rubbed into gums or stuffed into cavities for toothache.

Toxic part of the plant : all parts.

Main toxic constituents : tropane alkaloids

Leaves/flowers - mainly atropine Seeds/roots - mainly hyoscyamine Fruits – scopolamine

Dose: Accidentally (or intentionally) ingesting even a single leaf could lead to severe side effects

Symptoms: anticholinergicThirst, dry mouth, blurred vision, photophobia, urinary retention

occur soon after ingestion. Skin is hot, dry and flushed. Pupils are dilated and fixed. Cardiovascular effects are sinus

tachycarida, hypertension, supra/ventricular arrhythmias, orthostatic hypertension.

Severe poisoning causes disorientation, agitation, violent behaviour, convulsions, delirium, visual and auditory hallucinations, ataxia, respiratory depression, coma.

Mode of action:

It stimulates the central nervous system and simultaneously depresses peripheral nerves and dilates the pupils by peripheral action. The most probable action in this case is paralysis of the occulomotor nerve ending or its myoneural junction.

Treatment of poisoning:

Ipecac to induce emesis or gastric lavage.

Activated charcoal to reduce absorption of toxic substances.

Catheterization to empty bladder if necessary

Diazepam for hallucinations and delirium.

References: www.wikipedia.org/wiki/Datura_metel www.ces.ncsu.edu/depts/hort/consumer/

poison/Daturme.htm www.people.vcu.edu/~asneden/tropane

%20alkaloids.pdf waynesword.palomar.edu/ww0703.htm DMA Jayaweera. Medicinal plants used in Ceylon Parts

1-5. Colombo: National Science Foundation, 2006 Lucas GN, De Silva TUN. Poisonous plants of Sri Lanka.

Colombo: Sri Lankan College of Paediatricians, 2006

D. NiyangodaT.A. Ekanayaka

Scientific name: Abrus precatorius L.

Synonyms: A.minor, A.pauciflorus

Family: Leguminosae

Sinhala name: Olinda

Tamil name: Adisamiyai

Common names:• Abrus seed, crabs eye, Indian bead, Indian liquorice, wild liquorice,

lucky bean, prayer or rosary beads, precatory bean, weather plant, jumble beads, jequirity bean

Plant description: slender perennial twiner

Habitat: grows wild in dry regions of Sri Lanka at low elevations

Traditional use:• To cure itch, sores and wounds due to bites of dogs, cats and rats• Leaves: conjunctivitis, painful swellings; ground with lime for acne,

boils, abscesses and tetanus• Seeds: diabetes, Bright’s disease

Toxic part of the plant: seed• The most poisonous parts of the plant involved in poisoning are the small, scarlet

seeds, that have a black eye at the hilum

Toxicity: One seed well masticated can cause fatal poisoning (adults and children)

Main toxins: Abrin - concentrated in seeds

Mode of action:

– Abrin exerts its toxic action by attaching itself to the cell membranes– It has a direct action on parenchymal cells (eg liver and kidney cells) and red

blood cells

Clinical effects:

– Early features of toxicity - burning of the mouth and oesophagus, and severe gastroenteritis with vomiting, diarrhoea and abdominal pain. Haematemesis and melaena are less common

– Later - drowsiness, disorientation, weakness, stupor, convulsions, shock, hepatotoxicity, cyanosis, retinal haemorrhages, haematuria, and acute renal failure (oliguria) can occur

– (Contact with the eyes can cause conjunctivitis and even blindness)

Diagnosis:

– Diagnosis is made by the presence of the typical manifestations following ingestion: gastroenteritis with risk of dehydration, haematemesis and melaena. Drowsiness and convulsions may occur.

– Toxicological analysis of body fluids for the poison is not helpful.– Plant material, seeds or remnants of seeds, vomitus and gastric aspirate

should be collected in clean bottles for identification.

Main risks and target organs:

– The main risk is the severe gastroenteritis leading to dehydration and shock. Ingested seeds can affect the gastrointestinal tract, the liver, spleen, kidney, and the lymphatic system.

Treatment:

– Administration of fluids and electrolytes will alleviate dehydration.  

References:Jayaweera DMA. Medicinal plant use in Ceylon - Part 3. Colombo: The National Science

Foundation, 2006http://www.inchem.org/documents/pims/plant/abruspre.htm [accessed 03/07/2008]

Myristica fragrans

M. Jayasinghe

C.M.C. Indrajith

Scientific name: Myristica fragrans

Family: Myristicaceae

Sinhala name: Sadikka, Wasawasi (aril)

Tamil name: Adipam, Attigam, Kasam, Sadi, Sadikkay

English/common names: Nutmeg, Mace tree

Plant habitat:– A native of E.Moluccas and other Indian Islands– Now cultivated in Sri Lanka, Malaya, Philippines, W.Indies & South America

Traditional use: – As a spice in foods– As a traditional medicine for diarrhoea

Toxic part of the plant: seeds (nutmeg) and, to a lesser extent, the aril (mace)

Lethal dose: Humans: 1-3 nutmegs (5-15g) for adults, 2 nutmegs for childrenAnimals: oral dose of 24mg nutmeg oil per kg body weight

Main toxins: myristicin & elemicin

myristicin

Mode of action:• Elemicin undergoes oxidation of its oleficin side chain to produce TMA

(3,4,5-trimethoxyamphetamine), a psychotropic drug agent• Myristicin produces MMDA which is metabolised to form TMA. MMDA has a

higher potency than TMA• Nutmeg has monoamineoxidase inhibition properties and anti-prostaglandin

synthesis effects

Clinical features of poisoning:• symptoms are usually seen within 3-6 hours after ingestion and vary

according to the dose taken and the variability between different samples of nutmegs

• intoxication resembles anti-cholinergic intoxication ie profuse sweating, flushed face, dry mouth, burning epigastric pain, tachycardia, restlessness, giddiness, hallucinations

• unlike anti-cholinergic symptoms pupils constrict

Diagnosis:• Blood monitoring (electrolytes, liver enzymes, renal function) and urinalysis

Treatment of poisoning: symptomatic and supportive• Induce emesis (with ipecac) or gastric lavage• Activated charcoal• Diazepam for restlessness or hallucinations

References: http://www.rain tree nutmeg.com/plant images/myristica pic.htm [01.07.2008]; http://www.inchem.org/documents/pims/plants/pim335.htm [1.07.2008]; http://en.wikipedia.org/wiki/ [1 July 2008] ; Jayaweera DMA. Medicinal plant use in Ceylon - Part 3. Colombo: The National Science Foundation, 2006

Alocasia macrorrhiza

U.G.W.L.Jayeweera

C.Premely

Scientific name: Alocasia macrorrhiza

Synonyms: A.odora, A.commutata, Colocasia macrorrhiza, Caladium glycyrrhizum, Philodendron peregrinum, Arum grandiflorum

Family: Araceae (Magnoliophyta)

Sinhala name: Habarala

Tamil name: Parum sembu

English/common names: giant taro, elephant ear, ape flower

Plant habitat:• grows in all tropical countries including India,

Sri Lanka, Malaya & Philippines

Traditional use:• Acrid juice of the leaf gives instant relief to

stings of the giant nettle• Chopped leaves & roots used as an application

on painful joints• Cut stem + lime/water applied to dogs bites• Dried stems for haemorrhoids & chronic fevers• Crystals destroyed on boiling or roasting so

starch in stem can be used as a foodsource

Flower of the Alocasia plant

Taro corms

• Toxic part of the plant: all parts

• Main toxic constituent/s:• all parts of the plant contain specialized cells containing bundles of needle-

like calcium oxalate crystals and toxic proteins

• Mode of action:• When the plant is chewed the sharp crystals injure the mucous membrane

allowing toxic proteins to penetrate

• Lethal dose:• The extreme oropharyngeal response generally limits the amount of plant

ingested and oxalate absorbed through the oral mucosa is unlikely to cause systemic poisoning

• Symptoms:• Eating parts of the plant causes a severe burning in mouth and throat. Other

symptoms may include:– Redness, swelling, pain, burning pain of the tongue and mucous membranes,

profuse salivation, dysphagia– Swelling can rarely cause obstruction and respiratory compromise– Loss of speech may last several days and swelling more than a week

• Treatment of poisoning:• wipe out the mouth with a cold, wet cloth and give milk to drink• antihistamines, mouthwashes, antiseptics and steroids may be used

References: http://en.wikipedia.org/wiki/Alocasia [3 July 2008]; Jayaweera DMA. Medicinal plants used in Ceylon. Part 1. Colombo: The National Science Foundation, 2006; Lucas GN, De Silva TUN. Poisonous plants of Sri Lanka. Colombo: Sri Lankan College of Paediatricians, 2006

Nicotiana Nicotiana tabacumtabacum

Sanduni Sudusinge

Uthpala Siriwardhane

Mano Wickramarathne

Scientific nameScientific name Nicotiana tabacumNicotiana tabacum

FamilyFamily SolanceaeSolanceae

Sinhalese nameSinhalese name Dum kolaDum kola

Tamil nameTamil name Phaielai

English nameEnglish name TobaccoTobacco

Plant habitatPlant habitat native of tropical and subtropical native of tropical and subtropical America but it is now America but it is now

commercially commercially cultivated cultivated worldwideworldwide

Traditional useTraditional use - as an insecticide - as an insecticide - intestinal worms or constipation- intestinal worms or constipation

- dried tobacco leaves for chewing, - dried tobacco leaves for chewing, snuffing or smoking snuffing or smoking

Toxic part of the plantToxic part of the plant leaves, stems, roots and flowersleaves, stems, roots and flowers

Main toxic constituentsMain toxic constituents nicotinenicotine

Constituent typeConstituent type alkaloidalkaloid

Lethal doseLethal dose 0.5-1 mg/kg body weight nicotine (~ 40 - 0.5-1 mg/kg body weight nicotine (~ 40 - 60 mg)60 mg)

Mode of actionMode of action Nicotine binds stereo specifically to acetylcholine receptors Nicotine binds stereo specifically to acetylcholine receptors

at autonomic ganglia, the adrenal medulla, the at autonomic ganglia, the adrenal medulla, the neuromuscular junction and the brainneuromuscular junction and the brain

This evokes the release of catecholamineThis evokes the release of catecholamine nicotine produces ganglionic blockade, vagal afferent nerve nicotine produces ganglionic blockade, vagal afferent nerve

stimulation, or direct depressor effects mediated by action stimulation, or direct depressor effects mediated by action on the brainon the brain

Clinical features of poisoningClinical features of poisoning Mild: salivation, nausea, dizziness, drowsiness, headache, Mild: salivation, nausea, dizziness, drowsiness, headache,

vomiting, diarrhoea, hand tremorvomiting, diarrhoea, hand tremor Serious: mental confusion, circulatory collapse (shallow Serious: mental confusion, circulatory collapse (shallow

rapid pulse, ‘cold sweating’), convulsions, loss of rapid pulse, ‘cold sweating’), convulsions, loss of consciousness, cardiac arrest, respiratory paralysisconsciousness, cardiac arrest, respiratory paralysis

DiagnosisDiagnosis Blood monitoring (blood gases) and urinanalysisBlood monitoring (blood gases) and urinanalysis

Treatment of poisoningTreatment of poisoning induced emesis (ipecac) or gastric lavage and activated induced emesis (ipecac) or gastric lavage and activated

charcoalcharcoal supportive therapy directed towards maintaining supportive therapy directed towards maintaining

respiration and blood pressure (IV fluids) and controlling respiration and blood pressure (IV fluids) and controlling convulsionsconvulsions

References: References: www.wikipedia.com; www.inchem.org; www.wikipedia.com; www.inchem.org; Lucas GN, De Silva TUN. Poisonous plants of Sri Lanka. Colombo: Sri Lankan College of Paediatricians, 2006

Scientific name : Strychnos nux-vomica

Synonyms : S.lucida, S.colbrina, S.aromatica

Family : Loganiaceae

Sinhala name : Godakaduru, Visha kaduru

Tamil name : Eddi, Etti, Kagodi

English/common name : Poison nut, Nux vomica, Quaker buttons

Plant habitat :

dry forests of Ceylon, flowers in August A moderate sized or large tree with an erect trunk, Slide 5 Bark Wood Leaves Flowers Fruit

Traditional use : Root - cures fever and bites of venomous snakes Used for preparation of homeopathic medicine

Toxic part of the plant : seed (although all parts toxics) Wathsala Wimalasena Kanishka Jayaweera

Main toxic constituents : strychnine, (brucine)

Constituent type : alkaloids

.Lethal dose : plant poisoning is rare possibly due to bitter taste

The quantity of strychnine in one seed could be fatal

If seeds are swallowed uncrushed they are not poisonous

Mode of action : Strychnine is a potent convulsant. It causes increased reflex excitability in the spinal cord

Brucine – resembles strychnine activity but it is less potent

Clinical features of poisonings : Symptoms appear within 15 - 30 min of ingestion - Initial symptoms – bitter taste in mouth, feeling of suffocation

- Twitching of the muscles in neck, body and limbs - Extreme contractions affecting all muscles in the body - The patient is conscious and has intense pain. - Complications - lactic acidosis, rhabdomyolysis, acute renal failure - Death is caused by asphyxia or muscular paralysis

Diagnosis : Based on history of ingestion and development of muscular

stiffness

Strychnine (and brucine) can be measured chemically but there is no time to perform this procedure before treatment

Measure acidosis, serum potassium, SGOT, LDH, CPK etc

Treatment of poisonings : Activated charcoal

Support respiratory and cardiovascular functions If convulsions cannot be controlled with diazepam (IV or rectal), or

if they recur, administer phenobarbitone or phenytoin. Intubation with suxamethonium chloride may be necessary When convulsions and hyperactivity are completely controlled,

gastric lavage can be performed safely

References : http://www.inchem.org/documents/pims/plant [accessed 29 June 2008]; Jayaweera DMA. Medicinal plant use in Ceylon - Part 3. Colombo: The National Science Foundation, 2006; Lucas GN, De Silva TUN. Poisonous plants of Sri Lanka. Colombo: Sri Lankan College of Paediatricians, 2006

Scientific name: Gloriosa superba

Synonyms: G.simplex, Methonica doniana, Eugonia superba

Family: Colchicaceae, Liliaceae

Sinhala name: Niyangala

Tamil: Karththigaikkilangu, Illangalli

English/common names:• flame lily, glory lily, tiger claw

Plant habitat:• native of tropical Africa, India, Malaya, etc• found in low country Sri Lanka

Traditional use:• tuber – bruises and sprains

Poisonous parts of the plant:• The entire plant, especially the tubers, are extremely poisonous

Main toxic constituents: – colchicine (+ ‘gloriosine’ in tubers)

Constituent type: alkaloid

Mode of action:• Colchicine has an antimitotic effect

– It stops cell division by disrupting the spindle apparatus during the metaphase

– Cells with rapid turnover are affected (bone marrow, intestinal epithelium, hair-producing cells -> hair loss)

– It can alter neuromuscular function– (It can withstand drying, storage and boiling - tubers not a foodsource!)

Clinical features of poisoning:• Initial symptoms develop within 6-12 hours of ingestion

– burning pain, numbness, itching and tingling around the mouth and throat with thirst

– nausea, intense vomiting– abdominal pain, severe diarrhoea with blood and mucus

• These lead to– electrolyte imbalance, dehydration, hypovolaemic shock manifested

hypotension and tachycardia

• After 24 hours patients develop– Muscle weakness, myoglobinuria, bronchial constriction,

leucopenia, thrombocytopenia, clotting defects with bleeding, polyneuropathy cardiac arrhythmias, hepatic insufficiency, acute renal failure

• In severe cases there may be– Respiratory depression, confusion, delirium, convulsions, coma

• Death occurs due to shock or respiratory failure

Diagnosis:• Toxicological, biomedical, blood gas, haematological analyses

Treatment of poisoning:• hospitalize the patient immediately • induce vomiting (ipecac) / gastric lavage• give repeated activated charcoal• supportive care eg IV fluid, assisted

ventilation may be needed

References: Jayaweera DMA. Medicinal plant use in Ceylon - Part 3. Colombo: The National Science Foundation, 2006; http://www.inchem.org/documents/pims/plant (Accessed 4 July 2008]; Lucas GN, De Silva TUN. Poisonous plants of Sri Lanka. Colombo: Sri Lankan College of Paediatricians, 2006

Poisonus plants of Sri lankaPoisonus plants of Sri lanka RicinusRicinus communiscommunis

A.D.WickramasooriyaA.D.WickramasooriyaS.S.WijeramaS.S.Wijerama

Scientific name: Ricinus communis Linn. Synonyms:

Ricinus africanus Willd., Ricinus communis L. var. viridis (Willd.) Müll. Arg., Ricinus inermis Jacq., Ricinus lividus Jacq., Ricinus macrocarpus G. Popova, Ricinus microcarpus G. Popova, Ricinus persicus G. Popova, Ricinus speciosus Burm., Ricinus viridis Willd., Ricinus vulgaris Mill., Ricinus zanzibaricus G. Popova, Croton spinosus

Family: Euphorbiaceae (spurge family)

Sinhala name/s: Erandu, Tel-erandu, beheth endaru, thel endaru

Tamil name/s: Amanakku, Muttu-kottai, Andagam

English/common name/s: castor bean, castor-oilplant, Palma Christii

Plant habitat: Cultivated as a decorative plant in village gardens in Sri lanka Probably of African origin but now grows in tropical, subtropical and

temperate areas Commercially cultivated mainly in Brazil, India, Italy, etc.

Traditional use:In Sri lanka the root of the plant is used in pleurodynia (muscular rheumatism) and rheumatic pains while seeds are used for lumbago and sciaticaAfricans use the bark for stitching up wounds & as a dressing for soresLocal application of fresh leaves to the lactating breast is said to produce a powerful galactogogic action. They are also used headachesThe root is a remedy for abdominal pains and diarrhoea while root bark (and seed oil) is a purgative also used for skin diseases and sores

Toxic part of the plant: seeds are the most toxic part (leaves are also poisonous)

Lethal dose: 1mg/kg pure ricin in man• Ingestion of a single well chewed bean has caused death• 1-3 seeds can be fatal to a child• 2-4 seeds cause severe poisoning in an adult• poisoning is unlikely if seeds are swallowed without chewing

Main toxic constituent/s: Ricin

Constituent type: Glycoprotein or a toxalbumin• member of a class of plant toxins known as type 2 ribosome

inactivating proteins

Mode of action: Ricin impairs chain elongation in protein synthesis, causing cell death and tissue damage

Clinical features of poisoning: Early on - burning sensation of the mouth and throat occursAfter 3-6 hrs - nausea, vomiting, severe abdominal pain and diarrhoea resulting in dehydration electrolyte imbalance and shockCardiovascular - hypotention, tachycardia, ECG changes and circulatory failureOther - prostration, blurring of vision, loss of consciousness, convulsions, haemolysis, uraemia and liver necrosis

Diagnosis: Blood gases and electrolytes analysisClose monitoring of renal, hepatic hematological systems & blood clotting.Botanical & pharmacognostical identification of a sample of the plant or vomitusRadioimmunoassay with antiricin antibodies labeled with iodine 125 for ricin in plasma or urine

Treatment of poisoning: Induce emesis at home (ipecac)Immediate gastric lavage or activated charcoalCorrect fluid & electrolyte imbalance immediatelyIn case of bronchial asthma, oxygen, B2-agonist eg salbutamol and corticosteroids may be necessary (if acute poisoning occurred by inhalation) Antihistamines or corticosteroids may be beneficial in treating skin lesions (if acute poisoning occurred by skin exposure)

References:Jayaweera DMA. Medicinal plants used in Ceylon. Part 2. Colombo: The National Science Foundation, 2006 http://www.inchem.org/documents/pims/plant.htmwww.wikipedia.orgLucas GN, De Silva TUN. Poisonous plants of Sri Lanka. Colombo: Sri Lankan College of Paediatricians, 2006

• Scientific name: Manihot utilissima•Synonyms: Jatropha manihot (Kunth), Manihot manihot (Cockerell), Manihot melanobasis (Muell)•Family: Euphhorbiaceae •Sinhala name: "Manyokka" •Tamil names: “Maravalli” “Alavalli”•English /common name: cassava, manioc, tapioca

•Plant description: shrub with a big tuberous root •Plant habitat: The sweet and bitter cassava plants are indigenous to Southern and Central America but have been introduced to almost all tropical countries•Traditional use : Used as a food source. American Indians use the brown juice for burns

By : J.S.R.Sherif E.M.A.K.Ekanayaka

Manihot utilissimaManihot utilissima

Toxicity of the plant : The leaves and roots contain free and bound forms of the cyanogenic glycoside linamarin, which is converted to cyanide in the presence of linamarinase, a naturally occurring enzyme in cassava or via exposure to the atmosphere. (Slide 5)

Two varieties Sweet - contains as little as 20 milligrams of cyanide (CN) per kilogram of fresh rootsBitter - may produce more than 50 times as much (1 g/kg)The paralytic neurological disease caused by long-term consumption of cassava is called mantakassa. Yam that is cut, washed and boiled in an open container at 72°C for long enough will destroy the enzyme and any hydrocyanic acid formed will evaporate.

•Lethal dose : One dose of pure cassava cyanogenic glucoside (40mg) is sufficient to kill even a cow. Hence about 300 grams of fresh root is enough to kill an adult human and about 125 grams of fresh root would be enough to kill a child

•Mode of action :A "large" sudden dose (HCN) is highly poisonous to all humans and animals because it rapidly inactivates cellular respiration thereby causing death. This means that it stops cells from being able to use oxygen. The heart, respiratory system and central nervous system are most susceptible to cyanide poisoning and cease to function as a result of lack of oxygen.

Clinical features of poisoning :Acute: Within 3-6 hours of ingestion burning epigastric pain, vomiting, flushing of skin, dry mouth, tachycardia, pupil constriction, restlessness, giddiness and hallucinations occur.Chronic: initial symptoms are described as tremor, cramps, a heavy feeling and/or weakness in the legs, a tendency to fall down and difficulty remaining uprightThere is a visible hypertonic gait when walking or runningOccasionally there will be lower back pain, blurred vision, speech difficulties and/or paresthesia of the legs, but they disappear within a month, later some people will develop dysarthria, abnormalities of eye movement, hypertonicity of the arms

•DiagnosisAcute poisoning: signs of extreme metabolic acidosisChronic poisoning: a visible hypertonic gait when walking or running, bilateral brisk knee and Achilles tendon reflexes without signs of vertebral lesions The onset of the disease takes less than one week and then remains stableUrinary concentrations of (thiocyanate and linamarin are elevated) (Cyanide (CN-) is normally converted thiocyanate (SCN-) by the enzyme rhodanase)

•Treatment of poisoning There is no known treatment for cyanide poisoning . Treatment with sodium thiosulphate (Na2S2O3), a cyanide antidote, gave disappointing results. A good and varied diet, high dose multivitamins (specially B12 ,it detoxifies the HCN) and physical rehabilitation are advised.

References Affran DK. Cassava and its economic importance. Ghana Farmer 1968; 12(4): 172-178; Bellotti AC et al. Recent advances in cassava pest management. Ann Rev Entomol 1999; 44: 343-370; Lucas GN, De Silva TUN. Poisonous plants of Sri Lanka. Colombo: Sri Lankan College of Paediatricians, 2006

Presented by: ► M.M.JAYARATHNA

► H.V.N.LAKMALI

Botanical Name:Peganum harmala

FamilyName:Zygophyllaceae

Local Name: Ispandur Urdu Name: HarmalSinhala name: Rata aruda English name: Wild Rue Tamil name: SimaiyarawandiPart used: Whole plant Flowering: May - June

Plant habitatPlant habitatUS states ofUS states of

Arizona,California Arizona,California

Montana, Texas - Montana, Texas - grows in salt deserts grows in salt deserts and shrub lands. and shrub lands.

Grows in India, Persia,Grows in India, Persia,

Mediterranean Mediterranean region, Central Asia, region, Central Asia, Arabia, North AfricaArabia, North Africa

Multibranched, leafy, perennial,Multibranched, leafy, perennial,bright green, succulent herb.bright green, succulent herb.Leaves divided, seed angled,Leaves divided, seed angled,Flowers white, single.Flowers white, single.

Constituent type: Constituent type: alkaloidsalkaloids HarmalineHarmaline Harmine Harmalol Tetrahydroharmine VasicineVasicine

Mode of action:Mode of action: Harmaline is a reversible Harmaline is a reversible

monoamine oxidase inhibitor found monoamine oxidase inhibitor found especially in higher quatities in ripe especially in higher quatities in ripe seedsseeds

The plant also has antibacterial, The plant also has antibacterial, antioxidant, anti-inflammatory and antioxidant, anti-inflammatory and antitumour activityantitumour activity

CLINICAL FEATURESCLINICAL FEATURESOverdose is potentially comprised of hallucinations and Overdose is potentially comprised of hallucinations and

neurosensorial syndromes, bradycardia, low blood pressure, neurosensorial syndromes, bradycardia, low blood pressure, raised body temperature and gastrointestinal disturbances raised body temperature and gastrointestinal disturbances such as nausea and vomitingsuch as nausea and vomiting

DIAGNOSIS ONDIAGNOSIS ONPhysical examinationPhysical examination

TREATMENTSTREATMENTSSupportive therapySupportive therapy

IV fluidsIV fluidsAntacids (or H2 antagonists)Antacids (or H2 antagonists)

References: •IPCS Inchem.Peganum harmala [Accessed at http://www.inchem.org/documents/pims/plant 04 July 2008 ]•Massoud M et al. Toxicity of Peganum harmala: Review and a Case Report. Iranian Journal of Pharmacology & Therapeutics 2002: 1(1); 1-4

• Synonyms: Adenia hondala, Granadilla hondala, Modecca palmata

• Family: Passifloraceae

• Sinhala name/s: hondala

• Tamil name/s: kondala

• English/common name/s: ?

• Plant habitat:• large aerial plant climbing by tendrils attached to large trees growing in the

wet and dry zones along forest edges

• Traditional use: ?

• Toxic part of the plant: fruit (which closely resembles passion fruit -> accidental ingestion by children)

• Lethal dose: ?

• Main toxic constituent/s: a cyanogenic glycoside, a toxalbumin and emulsin (an enzyme)

• Constituent type: cyanogenic glycoside

Adenia palmata

• Mode of action:• 1st phase – hydrocyanic acid• 2nd phase – local toxalbumin effects• 3rd phase - hypersensitivity reaction

• Clinical features of poisoning:• 1st phase – vomiting, fever, restlessness, dizziness, disorientation,

abdominal pain and diarrhoea within one hour• 2nd phase – necrotising enteritis -> diarrhoea with blood and mucus,

abdominal colic and right iliac fossa tenderness after a variable period of time

• 3rd phase – myocarditis with ECG changes, tender hepatomegaly, retinopathy with papilloedema, exudates and haemorrhages may be seen 2-3 weeks after ingestion – all transient

• Diagnosis:• cardiac glycoside blood levels • seed remnants, vomitus, gastric aspirate may help identify• monitor serum potassium and electrolytes

• Treatment of poisoning:• if no vomiting occurs induce emesis with ipecac syrup or perform gastric

lavage• activated charcoal will help with the absorption of toxic substances• IV fluid therapy may be needed• antidotes for cyanide poisoning not usually necessary• blood transfusion may be necessary in the 2nd phase

Reference: Lucas GN, De Silva TUN. Poisonous plants of Sri Lanka. Colombo: Sri Lankan College of Paediatricians, 2006

Datura metel atropine, hyoscine, hyoscyamine alkaloids seed (all)

Gloriosa superba colchicine tuber

Nicotiana tabacum nicotine leaf (all)

Pagiantha dichotoma ? narcotic, datura-like seed

(Peganum harmala) harmaline seed

Strychnos nux vomica strychnine seed

Alocasia macrorrhiza calcium oxalate crystals (needle-like), toxic proteins

leaf/stem (all)

Anthurium sp.

Dieffenbachia sp.

Scindapsus aureus

Zantedeschia aethiopica

Cerbera manghas cerberine, odollum,thevetin cardiac glycosides fruit kernel

Thevetia peruviana thevetin A, theventin B fruit

Adenia palmata cyanogenic glycoside, toxalbumin, emulsin enzyme

cyanogenic glycosides fruit

Manihot utilissima linamarin, (linase enzyme) tuber

Abrus precatorius abrin toxalbumins seed

Jatropha curcas curcin seed (all)

Jatropha multifida Jatrophin

Ricinus communis ricin

Eucalyptus robusta oil of eucalyptus (eugenol) volatile oils all

Myristica fragrans myristicin seed (aril)

Amanita phalloides phalloidin, phalloin, phallolysinalpha, beta, gamma amanitin

phlallatoxins amatoxins

aerial parts (mushroom)