Revue Médicale - newhealthconcept.net

T O X I C o l o g yThe parts of the plant responsible for toxic effects were leaves (73%), seeds (57%), and rhizomesof Atractylis gummifera. All patients were symptomatic on admission. Symptoms resulting fromthe plant poisonings are presented in table 2.Table 2. Specific part of the plant used and symptoms of moderate and severe poisonings admitted to intensive care unitPlant Specific parts used SymptomsAtractylis gummifera Rhizomes Abdominal pain, vomiting, diarrhea, hematemesis, jaundice, atrophy of the liver,headache, drowsiness, dizziness, seizures, coma, repolarization disturbances,arrhythmia, conduction disturbances.Hypoglycemia, hyperkaliemia, hyperamylasemia, cytolysis, hyperbilirubinemia,Hypercreatinemia, metabolic acidosis.Datura stramonium Leaves, seeds Agitation, irritability, delirium, auditory hallucination, visual hallucination, coma,dilated pupil, dry mouth, urinary retention.Ricinus communis Leaves, seeds Abdominal pain, nausea, vomiting, diarrhea, melena, dehydration.High transaminase concentration.Nerium oleander Leaves Abdominal pain, bilious vomit, palpitation, drowsiness, first degree heart block.Peganum harmala Leaves, seeds Headache, drowsiness, visual hallucination, hypacousia, paresthesia.Citrillus colocynthis Fruits, seeds Abdominal pain, nausea, vomiting, diarrhea, dizziness.Urginea marithima Pulps Excitement, palpitation.Solanum nigrum Leaves, seeds Visual hallucination, auditory hallucination, excitement, delirium, ataxia, clippedspeech (recovery at the 30th hour).Artemisia absinthium Leaves Complete coma (recovery after 3 days).Artemisia herba alba Leaves Abdominal pain, pruritus, paresthesia.Ruta montana Leaves Agitation, irritability, hyper secretion, gastrointestinal bleeding.Signs and symptoms were neurological (91%), gastrointestinal (73%) and cardiovascular(18%).The common disorders in the 21 cases of Atractylis gummifera L poisonings were related toliver dysfunction manifested by liver failure and biological disturbances typical of hepatitis.Other causes of hepatitis were excluded. Lethal outcomes were documented in 19 Atractylisgummifera L poisoning.Treatment of the plant poisonings was mainly symptomatic by supporting vital functions (fluidand electrolyte replacement, cardiovascular support, vasopressors, respiratory support, controlof convulsions). Removal of ingested plant parts by gastric lavage or emesis associated withoral administration of activated charcoal reduced further absorption of toxin.DiscussionThe poison control center of Tunis provides 24-h emergency information to medical professionalsand other citizens throughout North Africa and also receives inquiries from European poisoncontrol centers. The use of common names in the identification of poisonous plants rather thanLatinized scientific nomenclature leads to misidentification of toxic plants (11). To overcomethis difficulty, poisonous plant identification databases which incorporate expert systems havebecome common. Many types of poisonous plant identification databases (textual, bibliographic,diagnostic expert system) have been described (12).Among the 478 species of plants commonly used in Tunisian traditional medicine, only 20species are considered toxic (6, 7). In our study, only Atractylis gummifera, Nerium oleander,and Citrillus colocynthis are known as poisonous. Plant poisonings therefore require otherhazardous circumstances (4, 13): drug addiction (Datura stramonium), the availability of herbalmedicines (Citrillus colocynthis, Datura stramonium, Nerium oleander); misidentification ofherbs (Atractylis gummifera, Rinicus communis, Solanum nigrum); and the use of higher thanrecommended doses (Ricinus communis, Peganum harmala). Confusion of an edible plantAtractylis gummifera LDatura stramoniumMED EMERGENCY - 2010 N o 621