Table 2.
Evaluation of causality and exclusion of alternate causes in clinical cases of medicinal plants from Mexico and Central America considered as toxic.
| Information of the patient (age, gender, country of residence) | Plant, way of administration, dose and part of the plant consumed, time of consumption if indicated | First symptoms (onset, in days, of the first symptoms) | Toxic effects (onset, in days, of the toxic effects) |
Clinical complications | Evaluation of causality (score) | Amount of information | Outcome (days) |
Alternate causes excluded | Reference |
|---|---|---|---|---|---|---|---|---|---|
| 9, M, Israel | Jatropha multifida Oral: >10 fruits |
Vomiting, watery diarrhea, and abdominal pain (1 h) | Gastroenteritis (1) | Hepatic enzymes elevation | Naranjo (5): probable | Enough | Recovered (5) | ND | [43] |
| 8, M, Israel | Vomiting, watery diarrhea, and abdominal pain (1 h) | Gastroenteritis (1) | Hepatic enzymes elevation | Naranjo (5): probable | Enough | Recovered (5) | ND | ||
|
| |||||||||
| 20 children; 8–13 years old, India |
Jatropha curcas, Oral: 1–4 seeds | 1-2 h | Vomiting (95%) Headache (40%) Fever (40%) Diarrhea (50%) |
ND | Regular | Recovered (6 hours) |
ND | [57] | |
|
| |||||||||
| 4, M, United States of America | Conium maculatum (piperidina 850 Ug/g plant), ND | Drowsiness (0.5 h) | Central nervous system depression (3 hours) | ND | Naranjo (6): probable | Regular | Recovered (6) | ND | [58] |
|
| |||||||||
| 19, F, Turkey | Conium maculatum, ND | Headache, blurred vision, and difficulty speaking (0.5 h) | Central nervous system depression (ND) |
Difficulty breathing | Naranjo (5): probable | Regular | Recovered (1) | ND | [59] |
|
| |||||||||
| 5, M, India | Argemone mexicana Oral: oil | Abdominal pain, loos of movements and swelling throughout the body (20) | Epidemic dropsy (ND) | ND | Naranjo (6): Probable |
Regular | Fatal (4) | Thalassemia and sickle cell disease (postmortem) | [60] |
| 10, M, India | Abdominal pain, fever, and shortness of breath (20) | ND | Naranjo (6): Probable |
Regular | Fatal (11) | Thalassemia and sickle cell disease (postmortem) | |||
|
| |||||||||
| 2, F, Mexico | Chenopodium ambrosioides, Oral: oil 80 ml (1,560 mg ascaridol) | Vomiting and CNS depression (3 h) | Multiple organ dysfunction syndrome (ND) | Seizures, periods of apnea | Naranjo (6): probable | Enough | Fatal (3) | Encephalopathy due to lead poisoning and organophosphates | [61] |
|
| |||||||||
| 64, F, United States of America | Cimicifuga racemosa, Oral: capsules (80 mg/day/2 months) | Painful nodules on her left foot (ND) | Cutaneous vasculitis (42) | ND | Naranjo (5): Probable | Regular | Recovered (90) | ND | [62] |
| 54, F, United States of America | Cimicifuga racemosa Oral: capsules (80 mg/day/4 months) | Ulcers (ND) | Cutaneous vasculitis (90) | ND | Naranjo (4): Possible | Regular | Recovered (90) | ND | |
|
| |||||||||
| 57, F, United States of America | Cimicifuga racemosa, Oral: capsules (without more specifications) | Lethargy and fatigue (14) | Autoimmune hepatitis (21) | ND | RUCAM (6) probable (Hepatocellular) Naranjo (7): Probable |
Enough | Recovered (14) | Hepatic disease, serology of negative hepatitis, normal Antinuclear antibodies | [63] |
|
| |||||||||
| 16, F, United States of America | Podophyllum peltatum Topical; 20% of the resin in tincture | Vomiting, watery diarrhea, and abdominal pain (7 h) | Multiple organ dysfunction syndrome (<1) | Neurological toxicity and respiratory complications | Naranjo (6): probable | Enough | Recovered (120) |
ND | [64] |
|
| |||||||||
| 18, F, United Kingdom | Podophyllum peltatum, Topical; 25% of the resin in tincture (7.5 ml = 1.88 g) | ND | Hypokalemia and peripheral neuropathy (<1) | Hypokalemia and peripheral neuropathy | Naranjo (5): probable | Regular | Recovered (90) |
Previous cesarean anesthesia not discarded | [65] |
|
| |||||||||
| 21, F, United States of America | Caulophyllum thalictroides, ND | ND | Nicotinic toxicity (<1) | Tachycardia, diaphoresis, abdominal pain, vomiting and muscle weakness | Naranjo (5): probable | Poor | Recovered (1) |
ND | [66] |
|
| |||||||||
| 40, M | Thevetia peruviana Oral: seeds | ND | Atrioventricular block (1) | Hyperkalemia, bradycardia | Naranjo (3): Possible | Regular | Recovered (3) | No cardiac history or vascular risk factor | [67] |
| 25, F | Cinchona pubescens Oral: leaves | ND | Atrioventricular block (1) | bradycardia | Naranjo (3): Possible | Regular | Recovered (2) | ND | |
| 75, F | Cinchona pubescens Oral: infusion | ND | Multiple organ dysfunction syndrome (ND) | ND | Naranjo (3): Possible | Poor | ND | ND | |
|
| |||||||||
| 20 patients: 9–50 years old, Mexico |
Metopium brownie, ND | 1–4 | Erythema (95%) Vesicles (60%) Papules (4%) Blebs (2%) |
ND | Regular | Recovered (ND) | Poison ivy | [68] | |
|
| |||||||||
| 27, M, United States of America | Larrea tridentata, Oral: 500 capsules (3–7/day/10 months) | Vomiting, watery diarrhea, and abdominal pain (ND) | Hepatic damage (ND) | ND | Naranjo (4): Possible RUCAM (4): Possible (Hepatocellular) |
Regular | ND | Hepatic disease, serology of negative hepatitis, (cytomegalovirus positive, ingestion of other plants and history of alcohol abuse) | [69] |
|
| |||||||||
| 13, M, Siri Lanka | Abrus precatorius Oral: 1 seed | Vomiting, watery diarrhea, and abdominal pain (5) | Pulmonary edema associated with hypertension (1) | Early renal parenchymal disease | Naranjo (5): probable | Enough | Recovered (3) | Organophosphate poisoning, acute glomerular nephritis, viral myocarditis, and dengue |
[70] |
|
| |||||||||
| 17, F, India | Abrus precatorius, Oral: 10 seeds | Gastrointestinal (4) | Idiopathic intracranial hypertension (6) | Hepatic failure, hyponatremia, and hypokalemia | Naranjo (5): Probable |
Enough | Recovered (21) | ND, intentional intake |
[71] |
| 28, F, India | Abrus precatorius, Oral: 7 seeds | Gastrointestinal (20) | Idiopathic intracranial hypertension (4) |
Seizures and respiratory failure | Naranjo (5): Probable |
Enough | Fatal (4) | ||
|
| |||||||||
| 18, M, United States of America | Datura inoxia, Oral: seeds | Incoherences and hallucination (ND) | Anticholinergic intoxication (<1) |
ND | Naranjo (4): Possible | Enough | Recovered (4) |
Methamphetamine intake, and intake of other unknown substances | [72] |
Age is given in years old; ND, not described; F, female; M, male.