Plant toxins and acute medicinal plant poisoning in children: A systematic literature review
Adel Ghorani-Azam1, Samaneh Sepahi2, Bamdad Riahi-Zanjani1, Anahita Alizadeh Ghamsari1, Seyed Ahmad Mohajeri3, Mahdi Balali-Mood1
1 Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
2 Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
3 Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences; Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
|Date of Submission||09-Jul-2017|
|Date of Decision||21-Oct-2017|
|Date of Acceptance||29-Dec-2017|
|Date of Web Publication||27-Mar-2018|
Prof. Mahdi Balali-Mood
Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad
Source of Support: None, Conflict of Interest: None
Background: For many years, medicinal plants and herbal therapy have been widely used in different societies for the treatment of various diseases. Besides their therapeutic potency, some of the medicinal plants have strong toxicity in human, especially in children and elderly. Despite common beliefs that natural products are safe, there have been few reports on their toxicities. Materials and Methods: In the present study, we aimed to systematically review the literature wherein acute plant poisoning and herbal intoxication have been reported in pediatric patients. After literature search and selection of the appropriate documents, the desired data were extracted and described qualitatively. Results: A total of 127 articles with overall 1453 intoxicated cases were collected. The results of this study showed that some medicinal plants can cause acute poisoning and complications such as hepatic and renal failure in children. Conclusion: The findings of this survey showed that acute plant poisoning can be life?threatening in children, and since a single?ingested dose of toxic plants can cause acute poisoning, parents should be aware of these toxic effects and compare the side effects of self?medication with its potential benefits.
Keywords: Herbal medicine, medicinal plant, pediatrics, poisoning, toxicology
|How to cite this article:|
Ghorani-Azam A, Sepahi S, Riahi-Zanjani B, Alizadeh Ghamsari A, Mohajeri SA, Balali-Mood M. Plant toxins and acute medicinal plant poisoning in children: A systematic literature review. J Res Med Sci 2018;23:26
|How to cite this URL:|
Ghorani-Azam A, Sepahi S, Riahi-Zanjani B, Alizadeh Ghamsari A, Mohajeri SA, Balali-Mood M. Plant toxins and acute medicinal plant poisoning in children: A systematic literature review. J Res Med Sci [serial online] 2018 [cited 2019 Mar 21];23:26. Available from: http://www.jmsjournal.net/text.asp?2018/23/1/26/228589
| Introduction|| |
In terms of prevention and treatment of diseases, medicinal plans are of particular importance in medicine. Given the importance of these plants in medicine, extensive researches have been performed in recent years to extract and characterize active products of herbal medicine. Proven beneficial effects of these plants, cheap and low expense, and compatibility with the environment are the most important reasons of using medicinal plants., The results of studies have shown that some active ingredients of medicinal plants are useful for pain relief. Findings have also shown that some medicinal herbs have antioxidant and anti-inflammatory effects in vitro., In addition, some medicinal plants are widely used for different therapeutic purposes including treatment of gastrointestinal tract and digestive diseases caused by microbial contamination. In this regard, various indigenous medicinal plants such as Cassia siamea, Flueggea virosa, Terminalia bellirica, and Terminalia chebula are used in different communities for the treatment of certain diseases such as malaria and gastrointestinal disease or as remedy in infants and children. It is estimated that close to 80% of people in different communities use different types of traditional medicine for the treatment of various disease. Nowadays, the use of natural remedies even in developed countries has become prevalent and these herbal products are routinely used in 18% of pediatrics institutions and 94% of other communities in Canada only for the treatment of various disease in children. It is shown that near to 20,000 herbal products are currently available on the market overall the world, and the annual trade turnover of medicinal plants is approximately 4 billion dollars only in the United States.
Besides their known beneficial properties, studies have shown that some medicinal plants such as Ephedra species, Aconitum species, Datura species, and Lobelia species in long-term use have strong toxic effect particularly in the children.,, Toxicological studies of medicinal herbs on animal models have shown that some of these plants such as daouri and juniper tar that are typically used to treat chronic eczema and other skin diseases may have nephrotoxicity or hepatotoxicity, suggesting that the use of these plants particularly in children should be reevaluated., Although it has been shown that natural or complementary and alternative medicines, particularly medicinal plants, have fewer side effects than chemical drugs, studies have shown that herbal medicines are not all safe for direct human use, especially in pediatric patients., The importance of acute poisoning is greater in children and especially neonates since their digestive and immune systems are not completely evolved. On the other hand, children are not aware of the dangers associated with the ingestion of every material. Studies have shown that although the overall number of mortality due to toxic plants is low, yet they are considered as an important cause of morbidity and mortality. On the other hand, since the toxicological information and antidote therapy of some medicinal herbs is not available, plant toxicity deserves greater attention. Since there are great concerns about the toxicological impact of medicinal plants in human, particularly in sensitive age groups, in this study, we aimed to systematically review the literature wherein toxicological impact of medicinal plant had been investigated in children. In addition, we aimed to introduce the plants that have been reported as poisonous, at least in children, to warn the health professionals about the consequences of consciously or unconsciously use of herbal medicine.
| Methods|| |
Methodology and selection criteria
A systematic literature search was performed in the PubMed, Scopus, and Google scholar in January 2017 to investigate the possible toxicity of medicinal plants in children from 1911 to 2017. On academic based and also according to the legal definition of the child by the UNICEF, childhood is considered as a period of time between the stages of birth and puberty. For consistency of this definition between male and female patients, and to ease the data extraction, children in this study were defined as those with <16 years old. Following terms “medicinal plant OR traditional medicine” and “pediatrics” were searched in the title, keywords, and abstract of articles to find appropriate documents in which the toxicity of traditional medicine had been investigated in children. For this purpose, following search method ([plant extract OR plant OR herbal medicine OR medicinal herb OR medicinal plant] AND [toxicity OR toxicology OR intoxication OR poisoning]) AND (children OR child OR adolescent OR teen OR teenager OR paediatric OR pediatric OR neonate OR newborn OR infant) was used in the PubMed and Google scholar by limiting the records to article with English language. It is suggested that PubMed, Scopus, and Google Scholar cover nearly all published articles in medical topics. However, to find potentially eligible documents, Scopus, Irandoc, Ovid, and ScienceDirect were also searched using a similar but customized method in which “medicinal plant OR traditional medicine” was searched as the main search term and then “children AND toxicity” was searched within the records.
With no strict inclusion criteria, all potentially eligible documents were included. Thus, almost all articles relevant to the purpose of this review wherein toxicological impact of medicinal plant had been investigated in children were included in this literature review and used for data synthesis. No time limitation was defined for the selection of eligible articles; however, to avoid misconception as well as to ease data extraction, the results were limited to articles with English languages, unless the desired data are extractable from the English abstract of those articles with languages other than English. Moreover, documents with duplicated data were excluded from further evaluation. In addition, articles with inadequate data, as well as editorials, conference papers, and review articles, were also excluded from additional assessment. Hence, according to aforementioned, the exclusion criteria in this review were as follows:
- Article with language other than English
- Documents with duplicated data
- Editorials, conference proceedings, and review articles
- Irrelevant articles or articles with inadequate data.
All procedures of literature search, article selection, and data extraction were performed by two reviewers independently according to the modified PRISMA Checklist 2009, a protocol for systematic reviews, in which the checklist has been modified to assess the nonrandomized trials. For this purpose and to avoid possible misinterpretation during data analysis, any probable discrepancies between the authors were resolved in each step before further data processing.
Data synthesis and the variable in the included literature
All necessary data including the name of author, sex ratio, date and origin of the publication, as well as the total number of studied population in the selected literature were recorded. Furthermore, other useful information including methods of assessment, study variables, and the main findings of each study was collected and used for qualitative data assessment. The variable of interests included blood metal, alcohol and electrolytes level, arterial blood gases, records of clinical features, patient outcome, and mortality rate. The reports of included manuscripts were qualitatively described after recording the desired data.
| Results|| |
Literature search and study selection
A total 7509 documents were found, of which 4126 articles were in the PubMed, 3237 articles were in the Scopus, and additional 146 documents were also found through search in Google scholar, Ovid, ScienceDirect, and manual reference list screening. Irandoc was also searched as a local Iranian database for plant toxicity in children. Afterward, among the collected documents, 5501 articles were excluded due to subject irrelevancy. Further 766 documents were also disqualified after excluding the articles that had been performed on animals or cell lines. Additional 772 articles were further omitted due to language irrelevancy. Furthermore, 343 review articles were also excluded from additional data processing. The documents were then reviewed, and after duplication removal and exclusion of irrelevant articles, finally, 127 papers were fully met the inclusion criteria. Due to the nature and sensitivity of the study and also ethical issues for study on newborns and children, most of the studies were case reports. Afterward, full text of 127 appropriate documents was collected and used for data extraction. The full process of literature selection is demonstrated in [Figure 1].
|Figure 1: Flowchart of the literature search and strategy for the selection of relevant document|
Click here to view
Description of included studies
In the present review, 127 articles with a total of 1453 study population were included and used for qualitative data assessment. The number of studied patients in the included documents varied from 1 to 220. The age of patients also varied from 21-day-old baby to 16-year-old children. The results of this study revealed that the use of traditional medicines, particularly medicinal plants such as Karwinskia humboldtiana, Lavandula angustifolia, Cannabis, and cinnamon oil, may lead to acute poisoning and central nervous system (CNS) toxicity in children., Depending on the route of exposure, the symptoms of acute poisoning differ; however, it has been reported that nausea, abdominal pain, dehydration, arrhythmia, vomiting, and bradycardia are the most prevalent symptoms. Rush or sensation of warmth, facial flushing, and/or oral burning are also reported when the plants are ingested orally.,
Findings have shown that intoxication with wild berries (Vaccinium species) and elephant' ear (Colocasia species), deadly nightshade (Atropa belladonna), and impila (Callilepis laureola) are more prevalent in Africa. Reports show that cutaneous application of cade oil (juniper tar) from Juniperus oxycedrus as mildly irritant oil, which is considered as a plant with antiseptic, antimicrobial, and fungal properties, can also cause serious acute poisoning in children. Medical records have shown that acute poisoning of the cade oil may also manifest as convulsions, acute pulmonary edema, renal failure, and hepatotoxicity. On the other hand, intoxication following oral ingestion of jimson weed (Datura stramonium) is reported from Asia, Africa, America, and Europe. Studies have also shown that Salvia officinalis (sage oil) is an epileptogenic plant, and even a single-ingested dose of this plant can cause seizure. Castor bean from Ricinus communis was also shown to have hepatotoxicity in children. Castor beans also contain ricin, which is a highly toxic and is used as chemical and biological weapon. Depending on the type of intoxication and the organs involved, mild-to-severe symptoms were reported in the literature. These symptoms include abdominal pain, diarrhea, vomiting, dermatitis, jaundice, decreased level of consciousness, tachycardia, dry mouth, confusion, incoherent speech, visual disturbances, hearing and visual hallucinations, coma, and deaths. The plants, type of intoxication, and clinical symptoms of acute plant poisoning are summarized in [Table 1].
|Table 1: The plants, type of intoxication, and clinical manifestations of plant poisoning in children|
Click here to view
| Discussion|| |
Native traditional medicine has been widely used in the treatment of various diseases in different cultures. Nowadays, medicinal plants have largely been used even in children, but the toxic effect and adverse reactions of these plants are an important and challenging issue in safety monitoring of these products. Although most of medicinal plants have traditionally been considered safe, many reports and medical data demonstrated that continuous use of these plants may be associated with respiratory, chronic liver injury, and in some cases liver failure., Clinical reports have shown that some herbal products such as Jin Bu Huan, a Chinese herbal remedy, can cause life-threatening symptoms such as bradycardia and respiratory and CNS depression in the users. According to a 10-year retrospective study of forensic autopsy cases, it is estimated that near to 7% of poisoning deaths in China are due to the use of poisonous plants. Medicinal plants and herbal remedies such as Thespesia acutiloba and Bersama abyssinica are currently used in South African for the treatment of various diseases, especially to combat pediatric infections. Toxicological studies have shown that most of these plant extracts have strong cytotoxicity and therefore cannot be considered as appropriate pediatric remedies. Other toxicological assessments have shown that some plants such as Pelargonium sidoides, Salvia officinalis, Datura stramonium, and eucalyptus can be hepatotoxic, epileptogenic, and hallucinogenic, and consumption of any part of these plants may result in hepatotoxicity, seizures, and severe acute anticholinergic poisoning, respectively.,, Furthermore, it is reported that death can occur from respiratory failure in Salvia officinalis poisoning.
Due to immature metabolic enzyme system, children and infants can be more susceptible to the toxic and side effects of these plants., Studies on some medicinal plants show that most of these herbal products are contraindicated during pregnancy and early age, and even some of these products can cause abortion, contraception, or severe intoxication. Although the results show that herbal intoxication occurs in all age groups, children as a sensitive groups are more susceptible to acute plant poisoning. Intoxication with plant toxins is a global health issue especially in sensitive age groups. Many case reports have described the toxicity of medicinal plants in human, particularly in pediatric patients. Findings show that children aged below 13 years comprises the majority (69.8%) of cases intoxicated with poisonous plant. Moreover, it is reported that about 60% of acute poisoning occurs in children younger than 20 years in Botswana and South Africa. Reports have also demonstrated that ingestion of Jatropha curcas seeds or fruits is an important cause of acute plant poisoning in Thailand and Paris, and Manihot esculenta is the most common cause of death in children in Thailand., Cyanide and salicylate toxicity has also been reported from ingestion of apricot seeds and Gaultheria species, respectively, and many of these intoxicated patients require intensive care therapy., The results of a 5-year retrospective study have shown that of 867 plant-intoxicated pediatric patients, 260 cases were due to apricot seed poisoning.
Findings have demonstrated that although herbal and traditional medicines may cause fewer side effects in comparison with synthetic drugs, medicinal plants may considerably contribute to acute poisoning incidents in children even with fatal outcomes. Many of these plants have some active components that may cause side effects or adverse reaction with neurotransmitters or other medicines; hence, the use of herbal remedies needs precaution at least in certain illnesses or during pregnancy and breastfeeding. The results of this survey and other studies suggest that adverse reactions of herbal medicines could be avoided by controlling the defined dose and also preventing self-medication. Since supportive therapy is the only therapeutic approach for the treatment of acute intoxication with plant, and there is no specific therapy for most plant poisonings, medicinal plants should be used with caution. Furthermore, because children are at a greater risk of ingesting poisonous plants, and since the major type of exposure to these plants was unintentional ingestion and the consequences could be fatal particularly in children and elderly, parents and health-care professionals should be aware of the safety and the toxic properties of medicinal plant. It is also shown that the community awareness regarding the risk factors associated with plant poisoning is limited. Similarly, findings have shown that the awareness is also limited among health-care workers regarding the plant poisoning in children. On the other hand, due to easily availability and increasing use of herbal products, health authorities should be aware of plant poisoning and the people should compare the side effects of self-medication with its potential benefits. Studies suggest that, like other drugs on the markets, medicinal plants must obey a well-established rule, wherein the dose per kilogram body weight, ingredients, suggested method of use, and possible side effects of the herbal products should be provided on the products.
| Conclusion|| |
The results of this literature review show that although medicinal plants and herbal remedies may have potential benefits for the treatment of certain diseases, they may cause acute poisoning, including CNS disorders and hepatotoxicity in children as a sensitive age group. In addition, findings showed that since a single ingested dose of toxic plants can cause acute poisoning, health professionals and parents should be aware of these toxic effects and compare the side effects of self-medication with its potential benefits. In addition, it is suggested to establish a local database in each country including the library and toxic profiles of medicinal plants with easily accessible for the parents and health-care workers.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sofowora A, Ogunbodede E, Onayade A. The role and place of medicinal plants in the strategies for disease prevention. Afr J Tradit Complement Altern Med 2013;10:210-29.
Tiwari S. CARROT – A potent cancer curing natural medicine. J Nat Prod 2016;9:4.
Braun L, Cohen M. Herbs and Natural Supplements, Volume 2: An Evidence-Based Guide. 4th
ed. Australia: Churchill Livingstone; 2015. p. 1368.
Chen X, Deng L, Jiang X, Wu T. Chinese herbal medicine for oesophageal cancer. Cochrane Database Syst Rev 2016;1:CD004520.
Mootoosamy A, Fawzi Mahomoodally M. Ethnomedicinal application of native remedies used against diabetes and related complications in Mauritius. J Ethnopharmacol 2014;151:413-44.
Ravipati AS, Zhang L, Koyyalamudi SR, Jeong SC, Reddy N, Bartlett J, et al.
Antioxidant and anti-inflammatory activities of selected Chinese medicinal plants and their relation with antioxidant content. BMC Complement Altern Med 2012;12:173.
Diaz P, Jeong SC, Lee S, Khoo C, Koyyalamudi SR. Antioxidant and anti-inflammatory activities of selected medicinal plants and fungi containing phenolic and flavonoid compounds. Chin Med 2012;7:26.
Sepahi S, Ghorani-Azam A, Sepahi S, Asoodeh A, Rostami S.In vitro
study to evaluate antibacterial and non-haemolytic activities of four Iranian medicinal plants. West Indian Med J 2014;63:289-93.
Ponnusankar S, Pandit S, Babu R, Bandyopadhyay A, Mukherjee PK. Cytochrome P450 inhibitory potential of triphala – A rasayana from ayurveda. J Ethnopharmacol 2011;133:120-5.
Ghosh N, Ghosh R, Mandal V, Mandal SC. Recent advances in herbal medicine for treatment of liver diseases. Pharm Biol 2011;49:970-88.
Johnston DL, Nagel K, O'Halloran C, Sencer SF, Kelly KM, Friebert S, et al.
Complementary and alternative medicine in pediatric oncology: Availability and institutional policies in Canada – A report from the Children's Oncology Group. Pediatr Blood Cancer 2006;47:955-8.
Buck ML, Michel RS. Talking with families about herbal therapies. J Pediatr 2000;136:673-8.
Asif M. A brief study of toxic effects of some medicinal herbs on kidney. Adv Biomed Res 2012;1:44.
] [Full text]
Phua DH, Zosel A, Heard K. Dietary supplements and herbal medicine toxicities-when to anticipate them and how to manage them. Int J Emerg Med 2009;2:69-76.
Wojcikowski K, Johnson DW, Gobé G. Medicinal herbal extracts-renal friend or foe? Part one: The toxicities of medicinal herbs. Nephrology (Carlton) 2004;9:313-8.
Edorh MS, Agbere S, Osei-Safo D, Adam Z, Agbonon A, Karou DS, et al.
Toxicological screening of daouri, a polyherbal formulation used in children in the central region of Togo. J Ethnopharmacol 2015;164:30-4.
Achour S, Abourazzak S, Mokhtari A, Soulaymani A, Soulaymani R, Hida M, et al.
juniper tar (Cade oil) poisoning in new born after a cutaneous application. BMJ Case Rep 2011;2011. pii: bcr0720114427.
Gill SK, Rieder MJ. Toxicity of a traditional Chinese medicine, Ganoderma lucidum
, in children with cancer. Can J Clin Pharmacol 2008;15:e275-85.
Bahorun T. Phytomedicines, functional foods, nutraceuticals and their regulation in Africa. In: Bagchi D, editor. Nutraceutical and Functional Food Regulations in the United States and Around the World. 2nd
ed. 225 Wyman Street, Waltham, USA: Academic Press, Elsevier; 2014. p. 404-14.
Eddleston M, Persson H. Acute plant poisoning and antitoxin antibodies. J Toxicol Clin Toxicol 2003;41:309-15.
Philippe G, Angenot L, Tits M, Frédérich M. About the toxicity of some strychnos species and their alkaloids. Toxicon 2004;44:405-16.
UNICEF. Convention on the Rights of the Child. Child Labor; 1989. p. 8.
Falagas ME, Pitsouni EI, Malietzis GA, Pappas G. Comparison of pubMed, scopus, web of science, and google scholar: Strengths and weaknesses. FASEB J 2008;22:338-42.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al.
The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Ann Intern Med 2009;151:W65-94.
Landelle C, Francony G, Sam-Laï NF, Gaillard Y, Vincent F, Wrobleski I, et al.
Poisoning by lavandin extract in a 18-month-old boy. Clin Toxicol (Phila) 2008;46:279-81.
Ocampo-Roosens LV, Ontiveros-Nevares PG, Fernández-Lucio O. Intoxication with buckthorn (Karwinskia humboldtiana
): Report of three siblings. Pediatr Dev Pathol 2007;10:66-8.
Perry PA, Dean BS, Krenzelok EP. Cinnamon oil abuse by adolescents. Vet Hum Toxicol 1990;32:162-4.
Sinniah D, Baskaran G. Margosa oil poisoning as a cause of Reye's syndrome. Lancet 1981;1:487-9.
Halicioglu O, Astarcioglu G, Yaprak I, Aydinlioglu H. Toxicity of Salvia officinalis
in a newborn and a child: An alarming report. Pediatr Neurol 2011;45:259-60.
Palatnick W, Tenenbein M. Hepatotoxicity from castor bean ingestion in a child. J Toxicol Clin Toxicol 2000;38:67-9.
Worbs S, Köhler K, Pauly D, Avondet MA, Schaer M, Dorner MB, et al.
Ricinus communis intoxications in human and veterinary medicine – A summary of real cases. Toxins (Basel) 2011;3:1332-72.
Patil MM, Patil SV, Akki AS, Lakhkar B, Badiger S. An arrow poison (Abrus precatorius
) causing fatal poisoning in a child. J Clin Diagn Res 2016;10:SD03-4.
Jang DH, Hoffman RS, Nelson LS. Attempted suicide, by mail order: Abrus precatorius
. J Med Toxicol 2010;6:427-30.
Alhamdani M, Brown B, Narula P. Abrin poisoning in an 18-month-old child. Am J Case Rep 2015;16:146-8.
Malangu N. Contribution of plants and traditional medicines to the disparities and similarities in acute poisoning incidents in Botswana, South Africa and Uganda. Afr J Tradit Complement Altern Med 2014;11:425-38.
Hussein A, Yassin A. Poisoning following ingestion of Narcissus tazetta
bulbs by schoolchildren. Isr Med Assoc J 2014;16:125-6.
Patel SS, Beer S, Kearney DL, Phillips G, Carter BA. Green tea extract: A potential cause of acute liver failure. World J Gastroenterol 2013;19:5174-7.
Khosrojerdi H, Mesri M. A prospective study on toxic plants in Iran (a case series). Int J Trav Med Glob Health 2013;1:14-7.
Vo KT, Horng H, Li K, Ho RY, Wu AH, Lynch KL, et al.
Cannabis intoxication case series: The dangers of edibles containing tetrahydrocannabinol. Ann Emerg Med 2017. pii: S0196-0644(17) 31657-8.
Le Garrec S, Dauger S, Sachs P. Cannabis poisoning in children. Intensive Care Med 2014;40:1394-5.
Spadari M, Glaizal M, Tichadou L, Blanc I, Drouet G, Aymard I, et al.
Accidental cannabis poisoning in children: Experience of the marseille poison center. Presse Med 2009;38:1563-7.
Molly C, Mory O, Basset T, Patural H. Acute cannabis poisoning in a 10-month-old infant. Arch Pediatr 2012;19:729-32.
Renier S, Messi G, Orel P. Acute cannabis poisoning in a female child. Minerva Pediatr 1994;46:335-8.
Amirav I, Luder A, Viner Y, Finkel M. Decriminalization of cannabis – Potential risks for children? Acta Paediatr 2011;100:618-9.
Macnab A, Anderson E, Susak L. Ingestion of cannabis: A cause of coma in children. Pediatr Emerg Care 1989;5:238-9.
de Sonnaville-de Roy van Zuidewijn ML, Schilte PP. Cannabis poisoning in a young child; don't ask about drugs. Ned Tijdschr Geneeskd 1989;133:1752-3.
Cipriani F, Mancino A, Pulitanò SM, Piastra M, Conti G. A cannabinoid-intoxicated child treated with dexmedetomidine: A case report. J Med Case Rep 2015;9:152.
Feliu C, Cazaubon Y, Fouley A, Guillemin H, Millart H, Gozalo C, et al.
Drowsiness and uncommon fever in a child after cannabis ingestion. Ann Biol Clin (Paris) 2017;75:462-5.
Shaw D, Pearn J. Oleander poisoning. Med J Aust 1979;2:267-9.
Camphausen C, Haas NA, Mattke AC. Successful treatment of oleander intoxication (Cardiac glycosides) with digoxin-specific fab antibody fragments in a 7-year-old child: Case report and review of literature. Z Kardiol 2005;94:817-23.
Brewster D. Herbal poisoning: A case report of a fatal yellow oleander poisoning from the Solomon Islands. Ann Trop Paediatr 1986;6:289-91.
Berdai MA, Labib S, Chetouani K, Harandou M. Atropa belladonna
intoxication: A case report. Pan Afr Med J 2012;11:72.
Caksen H, Odabaş D, Akbayram S, Cesur Y, Arslan S, Uner A, et al.
Deadly nightshade (Atropa belladonna
) intoxication: An analysis of 49 children. Hum Exp Toxicol 2003;22:665-8.
Laffargue F, Oudot C, Constanty A, Bedu A, Ketterer-Martinon S. Deadly nightshade (Atropa belladonna
) intoxication in a 2-year-old child. Arch Pediatr 2011;18:186-8.
Glatstein M, Danino D, Wolyniez I, Scolnik D. Seizures caused by ingestion of Atropa belladonna
in a homeopathic medicine in a previously well infant: Case report and review of the literature. Am J Ther 2014;21:e196-8.
Muniandy RK, Sinnathamby V. Salicylate toxicity from ingestion of traditional massage oil. BMJ Case Rep 2012;2012:1-3.
Singh RK, Singh D, Mahendrakar AG. Jatropha poisoning in children. Med J Armed Forces India 2010;66:80-1.
Chomchai C, Kriengsunthornkij W, Sirisamut T, Nimsomboon T, Rungrueng W, Silpasupagornwong U, et al.
Toxicity from ingestion of Jatropha curcas
('Saboo dum') seeds in thai children. Southeast Asian J Trop Med Public Health 2011;42:946-50.
Shah V, Sanmukhani J. Five cases of Jatropha curcas
poisoning. J Assoc Physicians India 2010;58:245-6.
Gupta A, Kumar A, Agarwal A, Osawa M, Verma A. Acute accidental mass poisoning by Jatropha curcas
in Agra, North India. Egypt J Forensic Sci 2016;6:496-500.
Akyildiz BN, Kurtoǧlu S, Kondolot M, Tunç A. Cyanide poisoning caused by ingestion of apricot seeds. Ann Trop Paediatr 2010;30:39-43.
Sayre JW, Kaymakcalan S. Cyanide poisoning from apricot seeds among children in central Turkey. N
Engl J Med 1964;270:1113-5.
Lasch EE, Shawa RE. Multiple cases of cyanide poisoning by apricot kernels in children from Gaza. Pediatrics 1981;68:5-7.
Sauer H, Wollny C, Oster I, Tutdibi E, Gortner L, Gottschling S, et al.
Severe cyanide poisoning from an alternative medicine treatment with amygdalin and apricot kernels in a 4-year-old child. Wien Med Wochenschr 2015;165:185-8.
Lesigang W. Fatal poisoning of a 3 year old child after eating apricot seeds. Osterr Z Kinderheilkd Kinderfuersorge 1949;3:329-33.
Nader R, Mathieu-Daudé JC, Deveaux M, Faure K, Hayek-Lanthois M, de Haro L, et al.
Child cyanide poisoning after ingestion of bitter almonds. Clin Toxicol (Phila) 2010;48:574-5.
Almış H, Karabiber H, Yakıncı C. Plant related poisonings in children: An evaluation of 23 cases. J Turgut Ozal Med Cent 2014;21:126-9.
Lopez clares F, Ocampo campos A, Guiza G. 2 cases of ascending paralysis caused by the ingestion of berries of Karwinskia humboldtiana
. Bol Med Hosp Infant Me×1960;17:889-98.
Martínez HR, Bermudez MV, Rangel-Guerra RA, de Leon Flores L. Clinical diagnosis in Karwinskia humboldtiana
polyneuropathy. J Neurol Sci 1998;154:49-54.
Bermúdez de Rocha MV, Lozano Meléndez FE, Salazar Leal ME, Waksman de Torres N, Piñeyro López A. Familial poisoning with Karwinskia humboldtiana
. Gac Med Me×1995;131:100-6.
Schmid T, Turner D, Oberbaum M, Finkelstein Y, Bass R, Kleid D, et al.
Respiratory failure in a neonate after folk treatment with broom bush (Retama raetam
) extract. Pediatr Emerg Care 2006;22:124-6.
Hansson A, Zelada JC, Noriega HP. Reevaluation of risks with the use of ficus insipida latex as a traditional anthelmintic remedy in the Amazon. J Ethnopharmacol 2005;98:251-7.
Kinamore PA, Jaeger RW, de Castro FJ. Abrus and ricinus ingestion: Management of three cases. Clin Toxicol 1980;17:401-5.
Wang CF, Nie XJ, Chen GM, Yu ZH, Li Z, Sun ZW, et al.
Early plasma exchange for treating ricin toxicity in children after castor bean ingestion. J Clin Apher 2015;30:141-6.
Ingle VN, Kale VG, Talwalkar YB. Accidental poisoning in children with particular reference to castor beans. Indian J Pediatr 1966;33:237-40.
Lopez Nunez OF, Pizon AF, Tamama K. Ricin poisoning after oral ingestion of castor beans: A case report and review of the literature and laboratory testing. J Emerg Med 2017;53:e67-71.
Challoner KR, McCarron MM. Castor bean intoxication. Ann Emerg Med 1990;19:1177-83.
Steenkamp V, Stewart MJ, Zuckerman M. Detection of poisoning by impila (Callilepis laureola
) in a mother and child. Hum Exp Toxicol 1999;18:594-7.
Watson AR, Coovadia HM, Bhoola KD. The clinical syndrome of impila (Callilepis laureola
) poisoning in children. S Afr Med J 1979;55:290-2.
Wainwright J, Schonland MM. Toxic hepatitis in black patients in natal. S Afr Med J 1977;51:571-3.
Laurens JB, Bekker LC, Steenkamp V, Stewart MJ. Gas chromatographic-mass spectrometric confirmation of atractyloside in a patient poisoned with Callilepis laureola
. J Chromatogr B Biomed Sci Appl 2001;765:127-33.
Darben T, Cominos B, Lee CT. Topical eucalyptus oil poisoning. Australas J Dermatol 1998;39:265-7.
Tibballs J. Clinical effects and management of eucalyptus oil ingestion in infants and young children. Med J Aust 1995;163:177-80.
Webb NJ, Pitt WR. Eucalyptus oil poisoning in childhood: 41 cases in South-East Queensland. J Paediatr Child Health 1993;29:368-71.
Spoerke DG, Vandenberg SA, Smolinske SC, Kulig K, Rumack BH. Eucalyptus oil: 14 cases of exposure. Vet Hum Toxicol 1989;31:166-8.
Mack RB. Fair dinkum koala kuisine – Eucalyptus oil poisoning. N
C Med J 1988;49:599-600.
Patel S, Wiggins J. Eucalyptus oil poisoning. Arch Dis Child 1980;55:405-6.
Flaman Z, Pellechia-Clarke S, Bailey B, McGuigan M. Unintentional exposure of young children to camphor and eucalyptus oils. Paediatr Child Health 2001;6:80-3.
Karunakara B, Jyotirmanju C. Eucalyptus oil poisoning in children. J Pediatr Sci 2012;4:e132.
Hockey R, Reith D, Miles E. Childhood poisoning and ingestion. Inj Bull 2000;60:1-6.
Craig JO. Poisoning by the volatile oils in childhood. Arch Dis Child 1953;28:475-83.
Foggie WE. Eucalyptus oil poisoning. Br Med J 1911;1:359-60.
Tiongson J, Salen P. Mass ingestion of Jimson Weed by eleven teenagers. Del Med J 1998;70:471-6.
Mathur GP, Mathur S. Dhatura poisoning. Indian Pediatr 1986;Suppl 23:176-8.
Gururaj AK, Khare CB. Dhatura poisoning: A case report. Med J Malaysia 1987;42:68-9.
Rakotomavo F, Andriamasy C, Rasamoelina N, Raveloson N. Datura stramonium
intoxication in two children. Pediatr Int 2014;56:e14-6.
Sevketoglu E, Tatlı B, Tuǧcu B, Demirelli Y, Hatipoglu S. An unusual cause of fulminant Guillain-Barré syndrome: Angel's trumpet. Pediatr Neurol 2010;43:368-70.
Glatstein MM, Alabdulrazzaq F, Garcia-Bournissen F, Scolnik D. Use of physostigmine for hallucinogenic plant poisoning in a teenager: Case report and review of the literature. Am J Ther 2012;19:384-8.
Nemcova. Sudden poisoning with thorn-apples in children. Cesk Pediatr 1958;13:350-1.
Sarracino JB. Children and the Jimson Weed. Med Bull US Army Eur 1957;14:18-9.
Mitchell JE, Mitchell FN. Jimson weed (Datura stramonium
) poisoning in childhood. J Pediatr 1955;47:227-30.
Vorokhobov LA, Karetnyi VM. Hyoscyamus and datura poisoning in children. Sov Med 1965;28:127-31.
Chang SS, Wu ML, Deng JF, Lee CC, Chin TF, Liao SJ, et al.
Poisoning by datura leaves used as edible wild vegetables. Vet Hum Toxicol 1999;41:242-5.
Hudson MJ. Acute atropine poisoning from ingestion of Datura rosei
Z Med J 1973;77:245-8.
Macchiaiolo M, Vignati E, Gonfiantini MV, Grandin A, Romano MT, Salata M, et al.
An unusual case of anisocoria by vegetal intoxication: A case report. Ital J Pediatr 2010;36:50.
Francis PD, Clarke CF. Angel trumpet lily poisoning in five adolescents: Clinical findings and management. J Paediatr Child Health 1999;35:93-5.
Djibo A, Bouzou SB. Acute intoxication with “sobi-lobi” (Datura
). Four cases in niger. Bull Soc Pathol Exot 2000;93:294-7.
Thabet H, Brahmi N, Amamou M, Ben Salah N, Hédhili A, Yacoub M, et al. Datura stramonium
poisonings in humans. Vet Hum Toxicol 1999;41:320-1.
Meiring Pde V. Poisoning by Datura stramonium
. S Afr Med J 1966;40:311-2.
Castañón López L, Martínez Badás JP, Lapeña López De Armentia S, Gómez Mora J, García Arias ML. Datura stramonium
poisoning. An Esp Pediatr 2000;53:53-5.
Torbus O, Jachimowicz M, Pikiewicz-Koch A, Broll-Waśka K, Lukasik E, Karczewska K, et al. Datura stramonium
poisoning – A new problem in children and young people's toxicomania in Poland. Wiad Lek 2002;55 Suppl 1:950-7.
Gibson RK. Jimson weed poisoning in children. J Indiana State Med Assoc 1961;54:1018-20.
Klein-Schwartz W, Oderda GM. Jimsonweed intoxication in adolescents and young adults. Am J Dis Child 1984;138:737-9.
Hamouda C, Amamou M, Thabet H, Yacoub M, Hedhili A, Bescharnia F, et al.
Plant poisonings from herbal medication admitted to a Tunisian toxicologic Intensive Care Unit, 1983-1998. Vet Hum Toxicol 2000;42:137-41.
Ertekin V, Selimoǧlu MA, Altinkaynak S. A combination of unusual presentations of Datura stramonium
intoxication in a child: Rhabdomyolysis and fulminant hepatitius. J Emerg Med 2005;28:227-8.
Forrester MB. Jimsonweed (Datura stramonium
) exposures in texas, 1998-2004. J Toxicol Environ Health A 2006;69:1757-62.
Adegoke SA, Alo LA. Datura stramonium
poisoning in children. Niger J Clin Pract 2013;16:116-8.
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Al-Shaikh AM, Sablay ZM. Hallucinogenic plant poisoning in children. Saudi Med J 2005;26:118-21.
Breton A, Merville R, Fontaine G, Dequidt J. Datura stramonium
poisoning in a child; case report. Pediatrie 1957;12:625-9.
Taha SA, Mahdi AH. Datura intoxication in Riyadh. Trans R Soc Trop Med Hyg 1984;78:134-5.
Akman SA, Cakir M, Baran M, Arikan C, Yuksekkaya HA, Tumgor G, et al.
Liver transplantation for acute liver failure due to toxic agent ingestion in children. Pediatr Transplant 2009;13:1034-40.
Şanlıdaǧ B, Derinöz O, Yıldız N. A case of pediatric age anticholinergic intoxication due to accidental Datura stramonium
ingestion admitting with visual hallucination. Turk J Pediatr 2014;56:313-5.
Locicero R. Poisoning by Jimson weed. Sem Med 1955;107:983.
Özkaya AK, Güler E, Karabel N, Namlı AR, Göksügür Y. Datura stramonium
poisoning in a child. Turk J Pediatr 2015;57:82-4.
Beno S, Osterhoudt KC, Meaney P. An exceedingly agitated patient. Pediatr Emerg Care 2004;20:845-8.
Bouziri A, Hamdi A, Borgi A, Hadj SB, Fitouri Z, Menif K, et al. Datura stramonium
L. poisoning in a geophagous child: A case report. Int J Emerg Med 2011;4:31.
Amini M, Khosrojerdi H, Afshari R. Acute Datura stramonium
poisoning in East of Iran – A case series. Avicenna J Phytomed 2012;2:86-9.
Wiebe TH, Sigurdson ES, Katz LY. Angel's trumpet (Datura stramonium
) poisoning and delirium in adolescents in Winnipeg, Manitoba: Summer 2006. Paediatr Child Health 2008;13:193-6.
Vichova P, Jahodar L. Plant poisonings in children in the Czech Republic, 1996-2001. Hum Exp Toxicol 2003;22:467-72.
Pilapil VR. Toxic manifestations of cinnamon oil ingestion in a child. Clin Pediatr (Phila) 1989;28:276.
Simpkiss M, Holt D. Digitalis poisoning due to the accidental ingestion of foxglove leaves. Ther Drug Monit 1983;5:217.
Mcnamara DG, Brewer EJ Jr., Ferry GD. Accidental poisoning of children with digitalis. N
Engl J Med 1964;271:1106-8.
Hecht H. Accidental digitalis poisoning in a 4-year-old child. Cesk Pediatr 1961;16:715-21.
Fazekas IG. Fatal poisoning of a child with wenckebach tablets (Digitalis-quinine-strychnine). Arch Toxikol 1960;18:224-8.
Kupper J, Reichert C. Intoxications with plants. Ther Umsch 2009;66:343-8.
Freeman R, Farrar JF, Robertson SE. Accidental digitalis poisoning in childhood. Med J Aust 1961;48:655-9.
Gittelman MA, Stephan M, Perry H. Acute pediatric digoxin ingestion. Pediatr Emerg Care 1999;15:359-62.
Davis JA, Ravishankar C, Shah MJ. Multiple cardiac arrhythmias in a previously healthy child: A case of accidental digitalis intoxication? Pediatr Emerg Care 2006;22:430-4.
Sinniah D, Baskaran G, Vijayalakshmi B, Sundaravelli N. Margosa oil poisoning in India and Malaysia. Trans R Soc Trop Med Hyg 1981;75:903-4.
Lai SM, Lim KW, Cheng HK. Margosa oil poisoning as a cause of toxic encephalopathy. Singapore Med J 1990;31:463-5.
Dhongade RK, Kavade SG, Damle RS. Neem oil poisoning. Indian Pediatr 2008;45:56-7.
Sundaravalli N, Raju BB, Krishnamoorthy KA. Neem oil poisoning. Indian J Pediatr 1982;49:357-9.
Sinniah D, Baskaran G, Looi LM, Leong KL. Reye-like syndrome due to margosa oil poisoning: Report of a case with postmortem findings. Am J Gastroenterol 1982;77:158-61.
Senanayake MP, Rupasinghe S, Dissanayake PV. Margosa (Kohomba) oil induced toxic encephalopathy following home remedy for intestinal worms. Ceylon Med J 2009;54:140.
Santhanakrishnan BR, Balagopalaraju V. Poisoning in childhood. Indian J Pediatr 1972;39:158-64.
Ramesh S, Srikanth S, Parvathy VR. Poisoning in children. Indian J Pediatr 1987;54:769-73.
Kumar S, Kumar N. Neem oil poisoning as a cause of toxic encephalopathy in an infant. Indian J Pediatr 2014;81:955.
Ekor M. The growing use of herbal medicines: Issues relating to adverse reactions and challenges in monitoring safety. Front Pharmacol 2014;4:177.
Centers for Disease Control and Prevention (CDC). Jin bu huan toxicity in children – Colorado, 1993. MMWR Morb Mortal Wkly Rep 1993;42:633-6.
Zhou L, Liu L, Chang L, Li L. Poisoning deaths in central China (Hubei): A 10-year retrospective study of forensic autopsy cases. J Forensic Sci 2011;56 Suppl 1:S234-7.
Mnengi D, Kappo A, Kambizi L, Nakin M. Cytotoxicity of selected medicinal plants used in Mt. Frere District, South Africa. Afr J Tradit Complement Altern Med 2014;11:62-5.
Ginsberg G, Hattis D, Sonawane B, Russ A, Banati P, Kozlak M, et al.
Evaluation of child/adult pharmacokinetic differences from a database derived from the therapeutic drug literature. Toxicol Sci 2002;66:185-200.
Lu H, Rosenbaum S. Developmental pharmacokinetics in pediatric populations. J Pediatr Pharmacol Ther 2014;19:262-76.
Rodrigues E. Plants of restricted use indicated by three cultures in Brazil (Caboclo-river dweller, Indian and Quilombola). J Ethnopharmacol 2007;111:295-302.
Sriapha C, Tongpoo A, Wongvisavakorn S, Rittilert P, Trakulsrichai S, Srisuma S, et al.
Plant poisoning in Thailand: A 10-year analysis from ramathibodi poison center. Southeast Asian J Trop Med Public Health 2015;46:1063-76.
Langrand J, Médernach C, Schmitt C, Blanc-Brisset I, Villa AF, de Haro L, et al.
Poisoning with Jatropha curcas
: 24 cases reported to Paris and Marseille Poisons Centers. Bull Soc Pathol Exot 2015;108:139-43.
Geçim NO, İkincioǧullari D, Harmanchi N. Evaluation of childhood poisoning cases reported to national poison centre: Five years of retrospective study. Turk Klin J Pediatr Sci 2006;2:1-4.
Consolini AE, Ragone MI. Patterns of self-medication with medicinal plants and related adverse events – A South American survey. Curr Drug Saf 2010;5:333-41.
Dayasiri MB, Jayamanne SF, Jayasinghe CY. Plant poisoning among children in rural Sri Lanka. Int J Pediatr 2017;2017:6187487.
Oulmaati A, Hmami F, Achour S, Bouharrou A. Severe poisoning by traditional medication in the newborn. Arch Pediatr 2017;24:833-6.