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toxidrome
Nicotinic toxidrome
botanicals
definition
nicotinic toxidrome
the following toxicity information is largely derived from poisonings, overdoses and research on isolated constituents; used with appropriate clinical judgment and cautious prescribing, herbs are safe and efficacious
plants included:
» Lobelia inflata
» Nicotiana tabacum
» Lobelia inflata:
treatment of overdose: activated charcoal; respiratory and vascular support are necessary
In contrast to nicotine from Nicotiana tabacum, lobelia's alkaloid, lobeline, serves as a violent nauseant, thus preventing many potential overdoses. Narcotic effects leading to hallucinogenic stupors have been noted (Duke, p. 282)
toxic dose varies; some are sensitive at therapeutic dose; high doses can lead to death; has similar action to nicotine, but 1/20 to 1/5 as potent
Nicotinic toxidrome: characterized by headache, diaphoresis, esophageal burning, nausea, vomiting, and a weak and hasty heartbeat. The patient presents with signs of muscular incoordination and medullary paralysis that ascends from the feet upwards. A general state of weakness and depression proceeds to prostration, convulsions, coma, reduced body temperature, and death from respiratory failure (AMA, p.108; Brundage, p. 173; Ellingwood, p. 236; Fuller and McClintock, pp. 185-186; Levy and Primack, p. 111-112; Morton, p. 371; Woodward, p. 182)
EKG changes include sinus arrhythmia, bundle branch block, and extra systole (Goodman and Gilman)
laboratory test results: glucosuria and transient hyperglycemia (von Oettingen, p. 453)
» Nicotiana tabacum:
treatment of overdose: activated charcoal; respiratory and vascular support are necessary
Intoxication results include: nausea, vomiting, diaphoresis, and abdominal pain. Neurotoxic effects include vertigo, confusion, sensory disturbances, and marked weakness. Patient experiences miosis followed by mydriasis; the pulse decreases and then increases; hypertension develops, followed by hypotension. Irregular respirations have been noted, followed by a curare-like onset of apnea. Hyperthermia, shaking, quivering, twitching and convulsions may also be seen. Vasomotor collapse, accompanied by respiratory paralysis, precedes death (AMA, p. 123; Brinker, p. 67)
footnotes
Brinker F. 1996. The Toxicology of Botanical Medicines, rev. 2nd ed., Sandy, Oregon: Eclectic Medical Publications.
Brundage, A.H. 1929. A Manual of Toxicology, 15th ed. New York: D. Appleton and Co.
Duke, J.A. 1985. C.R.C. Handbook of Medicinal Herbs. Boca Raton, FL: The C.R.C. Press.
Ellingwood, F. 1898. American Materia Medica, Therapeutics, and Pharmacognosy. Portland, OR: Eclectic Medical Publications.
Fuller, T.C., and McClintock, E. 1986. Poisonous Plants of California. Los Angeles: University of Southern California Press.
Goodman, L.S., and Gilman, A. 1980. The Pharmacological Basis of Therapeutics, 6th ed. New York: MacMillan Publishing Company, Inc.
Lampe, K.F., and McAnn, M.A. 1985. AMA Handbook of Poisonous and Injurious Plants. Chicago: American Medical Association.
Levy, C.K.; and Primack, R.B. 1984. A Field Guide to Poisonous Plants and Mushrooms of North America. The Stephen Green Press.
Morton, J.F. 1977. Major Medicinal Plants: Botany, Culture, Uses. Springfield, IL: Charles C. Thomas.
von Oettingen, W.F. 1958. Poisoning: A Guide to Clinical Diagnosis and Treatment. Philadelphia: W.B. Saunders and Company.
Woodward, L. 1985. Poisonous Plants: A Color Field Guide. New York: Hippocrene Books, Inc.