Selected Topics: ToxicologyBaptisia Poisoning: A New and Toxic Look-alike in the Neighborhood
Introduction
The clinical course of 2 patients who ingested Baptisia plant material that they had foraged is presented. Baptisia, a perennial native prairie plant, is commonly found in residential gardens as an ornamental plant, in municipal “rain gardens” for water control, and in native and restored prairie habitat. Cytisine, an alkaloid with nicotinic acetylcholine receptor agonist properties, is a component of Baptisia (Figure 1). Nicotinic acetylcholine receptor agonists have been long known to produce skeletal muscle weakness, but receptor subunits have also been more recently discovered in the cerebellum, consistent with the symptoms of the patients presented (1). Baptisia bears a striking similarity to asparagus for a brief period after its emergence in early spring, making its “look-alike” characteristic a risk for uninformed foragers, as the patients in this series demonstrate (Figure 2, Figure 3). Baptisia herbal products have been described as having wide-ranging health benefits, especially for infections such as colds (2). Baptisia products are widely available in health food stores and online retailers. Although no toxic effects from its medicinal use have been reported to date, its use as a component to many health supplements could represent a potential second source of cytisine toxicity.
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Case Report
An 85-year-old woman (Patient 1) and her 48-year-old daughter (Patient 2) presented to the Emergency Department (ED) with abdominal discomfort, nausea, recurrent vomiting, diarrhea, and dizziness. Both patients had eaten dinner immediately prior to arrival. The family believed that “wild asparagus” was the culprit ingestion, as they had collected it from a municipal rain garden immediately outside their home and were assured by their housekeeper that the plant was safe to eat. Both patients'
Discussion
Baptisia australis, commonly known as blue wild indigo or false indigo, is well known to result in nausea, vomiting, and diarrhea upon ingestion [(3), pp. 309–10]. It is a perennial prairie forb that is long stalked with bright blue flowers in its mature stage, and is found in both gardens and natural areas (4). It is distributed throughout much of the Midwest, eastern and southern United States, and Ontario (5). In early spring emergence, it bears a striking resemblance to common asparagus (
Why should an emergency physician be aware of this?
This case report of Baptisia ingestions represents the convergence of public trends. Foraging is increasingly common given trends in organic, local, and sustainable lifestyles (13). A small but growing trend in residential gardens and lawns is full or partial replacement with native prairie plantings to enhance habitat for wildlife. Municipalities are utilizing native prairie plantings in residential areas for sustainable water retention and augmentation for storm sewer runoff (14). Baptisia, a
Acknowledgments
We want to thank Johanna Oosterwyk, DC Smith Greenhouse Manager, Horticulture Department, College of Agricultural and Life Sciences University of Wisconsin, for her invaluable help in plant identification and use of plant photographs (Figure 4), and Dr. Christina Iyama, for review of the manuscript. We would also like to thank the patients in the above case for allowing us to come to their home to retrieve and photograph the specimens.
References (14)
- et al.
A randomized, double-blind, placebo-controlled, clinical dose-response trial of an extract of Baptisia, Echinacea and Thuja for the treatment of patients with common cold
Phytomedicine
(2005) - et al.
Cerebellar nicotinic cholinergic receptors are intrinsic to the cerebellum: implications for diverse functional roles
Cerebellum
(2011) Manual of materia medica and pharmacology
(1927)- et al.
Poisonous plants of North Carolina
(1997) - United States Department of Agriculture: Natural Resources Conservation Service Plant Guide. Baptisia australis....
- Brown R. The root and leaves of Baptisia tinctoria. King's American Dispensatory, 1898. 1999–2012 Henriette Kress....
The names of plants
(2008)
Cited by (6)
Cytisine: State of the art in pharmacological activities and pharmacokinetics
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2016, Journal of Emergency MedicineDifferent processing methods change the oral toxicity induced by Sophora alopecuroides seeds and the contents of five main toxic alkaloids from the ethanol extracts determined by a validated UHPLC–MS/MS assay
2018, Revista Brasileira de FarmacognosiaCitation Excerpt :Cytisine is a known partial agonist of α4β2 nicotinic acetylchloline receptor (Han et al., 2016), and has the teratogenicity (Barceloux, 2008) and high brain toxicity in spontaneously hypertensive rats (Simeonova et al., 2010). The negative side effects also include headache, nausea, vertigo, vomiting, diarrhea, chest pain, and in higher doses, convulsions and respiratory failure (Anderson et al., 2015). In this paper, we observed a very close correlation between the content of cytisine and the toxicity of different processing methods (r = 0.8589).
Cerebellotoxic Agents
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