Chapter 129

#### High-Yield Facts

• The vast majority of plant exposures are unintentional and involve small quantities and are typically asymptomatic.

• Gastrointestinal upset is the most common manifestation of symptomatic exposures.

• Foxglove, oleander, and lily of the valley are among several species of plants that contain cardiac glycosides and may cause toxicity similar to digoxin poisoning.

• The typical mushroom ingestion by children involves the “backyard mushroom” and toxicity is unlikely.

• The majority of toxic mushrooms taken belong to the gastrointestinal irritant group, and symptoms occur within the first few hours of ingestion.

• Most potentially life-threatening mushrooms will have an onset of symptoms 6–8 hours, or even longer, after ingestion.

#### Plants

Exposure to potentially toxic plants is a common occurrence in children, especially among those who are ≤5 years of age.1 The risk associated with plant exposures is very low, resulting in minimal morbidity and nearly no mortality.1 The American Association of Poison Control Centers report that plant exposures are the 12th most common causes of toxicity in children ≤5 years.1,2 There were only four plant-related fatalities. One involved the unintentional ingestion of the highly toxic Conium maculatum (poison hemlock) while the other three were the consequence of children being administered home remedies that were produced from manipulating botanical material.1 Ingestion is the most common route of exposure, and unless stated otherwise, all of the information in this chapter will pertain to the ingestion route of exposure.

Although most plant exposures have a positive outcome and do not require medical attention, the exposures often result in caretaker anxiety and emergent interaction with the health care system. Children ≤5 years are vulnerable to unintentional plant exposures for a variety of reasons, which include carelessness by adults (placing plants in areas that are accessible to children), curiosity and hand-to-mouth activity of children, attractive plant colors and fragrances, and associating household and exterior plants as food. Contrary to poisoning exposures in general, where only 52.1% of the exposures involve children ≤5 years, 81.2% of all plant exposures occur in children ≤5 years.1 Even more noteworthy is the preponderance of those exposures in children ≤1 year of age where nearly 60% of the plant exposures occurred.1 Children in this age group are vulnerable due to their rapidly developing mobility, hand-to-mouth activity, and improving motor skills, which allow them to ingest plant material such as leaves, stems, and berries that have fallen onto the floor or low tables.

Unintentional (accidental) plant exposures are uncommon in children aged 6–12. Fatalities, rarely, if ever occur and the outcomes of exposures are generally positive. However, in the 13–19-year age group, plant exposure is typically due to recreational substance use. Morbidity increases, and there are rare fatalities.

#### General Management

The physician managing a child who has ingested a plant is faced with four challenges: identification of the plant, ...

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