Plant and Food Toxins

Anticholinergic Poisoning - Dry & Mad Plants

• Sources: Datura stramonium (Jimsonweed, Thornapple), Atropa belladonna (Deadly Nightshade).
  • Toxins: Atropine, scopolamine, hyoscyamine.
• Mechanism: Competitive antagonism of acetylcholine at muscarinic receptors.
• Clinical Features (📌 Mnemonic: "Mad as a hatter, Blind as a bat, Red as a beet, Hot as a hare, Dry as a bone"):
  • Altered mental status (delirium, confusion, hallucinations).
  • Mydriasis (dilated pupils), blurred vision, cycloplegia.
  • Flushed, warm, dry skin (anhidrosis).
  • Hyperthermia.
  • Dry mucous membranes, urinary retention, decreased bowel sounds.
  • Tachycardia, hypertension.
• Management:
  • Supportive care: ABCs, IV fluids, cooling measures.
  • Benzodiazepines (e.g., lorazepam) for agitation and seizures.
  • Physostigmine: 0.5-2 mg IV slowly for adults in severe cases (e.g., refractory seizures, severe delirium) with cardiac monitoring. Contraindicated in TCA overdose.

⭐ Datura poisoning is notorious for causing delirium with vivid hallucinations and is sometimes used illicitly for its psychoactive effects.

Cardiotoxic Plants - Heartbreak Weeds

Plants & Toxins:

• Oleander (Thevetia peruviana, Nerium oleander): Oleandrin, thevetin.
• Foxglove (Digitalis): Digoxin. Mechanism: Na+/K+ ATPase inhibition → ↑ intracellular Ca2+. Clinical Features:
• GIT: Nausea, vomiting.
• CVS: Bradycardia, AV blocks, arrhythmias.
• Hyperkalemia (e.g., K+ > 5.5 mEq/L).
• Visual: Xanthopsia. ECG:
• Bradycardia, AV blocks.
• Scooped ST segments (📌 'Reverse tick').
• Ventricular arrhythmias. Management:
• Supportive, activated charcoal (early).
• Atropine for bradycardia.
• Digoxin-Specific Fab: for life-threatening arrhythmias, end-organ dysfunction, or K+ > 5.5 mEq/L.

⭐ Hyperkalemia is a hallmark of severe cardiac glycoside poisoning and correlates with mortality. Significant hyperkalemia (e.g., K+ > 5.5 mEq/L) is a poor prognostic sign.

Neurotoxic Food & Plants - Nerve Wreckers

• Lathyrism (Khesari Dal Poisoning)

  • Source: Lathyrus sativus (Khesari dal).
  • Toxin: $\beta$-N-oxalyl-amino-L-alanine (BOAA).
  • Chronic exposure: Leads to irreversible spastic paraparesis (neurolathyrism). 

• Strychnine Poisoning

  • Source: Strychnos nux-vomica (Kuchala seeds).
  • Mechanism: Glycine antagonist in spinal cord.
  • Acute presentation: Opisthotonus, risus sardonicus, generalized muscle spasms, seizures, intact sensorium until late. 

• Mushroom Neurotoxins

  • Psilocybin-containing mushrooms: Hallucinations, altered perception.
  • Ibotenic acid/Muscimol (e.g., Amanita muscaria): Confusion, delirium, ataxia, muscle jerks (GABAergic effects).

⭐ Lathyrism, caused by prolonged consumption of Khesari dal (Lathyrus sativus), leads to irreversible spastic paraparesis due to its toxin BOAA ($\beta$-N-oxalyl-amino-L-alanine).

Hepatotoxic & Cellular Toxins - Organ Attackers

• Aflatoxins

  • Source: Aspergillus (grains, peanuts).
  • Effect: Hepatotoxic; chronic exposure ↑HCC risk.

• Mushroom Poisoning: Amanita phalloides (📌 'Death Cap')

  • Toxins: Cyclopeptides (amatoxins, phallotoxins).
  • Phases: 1. Latency (6-24 hrs); 2. GI distress (N/V/D); 3. Hepatic failure (jaundice).

  • The latent period in Amanita phalloides poisoning is a key diagnostic clue, often delaying treatment. ⭐

  • Management Approach:

• Ricin & Abrin (📌 'RIP' - Ribosome Inactivating Proteins)

  • Mechanism: Inhibit 60S ribosome → stop protein synthesis → cell death.
  • Ricin: Ricinus communis (castor beans). Highly toxic.
  • Abrin: Abrus precatorius (Rosary pea). More potent.

High‑Yield Points - ⚡ Biggest Takeaways

• Datura poisoning: anticholinergic symptoms; physostigmine is the antidote.
• Amanita phalloides: delayed GI symptoms, then hepatorenal failure; use silibinin or NAC.
• Lathyrism (Lathyrus sativus / Kesari dal): irreversible spastic paraparesis.
• Aflatoxins (Aspergillus on grains): hepatotoxic, linked to hepatocellular carcinoma.
• Oleander (Kaner): cardiac glycoside toxicity; manage like digoxin, consider DigiFab.
• Ricin (castor beans): severe gastroenteritis, leading to multi-organ damage.
• Ergotism (contaminated rye): peripheral vasoconstriction (gangrene) and convulsions.