Gelsemium Poisoning in a Family after Consumption of Cassytha Filiformis Linn. Collected in the Countryside

Abstract

Acute poisoning through consumption of plants picked from the wild is not uncommon in Hong Kong. Gelsemium elegans Benth. is one of the most poisonous native plants which can cause toxicities ranging from dizziness to respiratory depression and muscle paralysis after ingestion. We report three cases of gelsemium poisoning in a family after consumption of a homemade herbal soup made of a plant believed to be Cassytha filiformis Linn. collected in the countryside. All of them presented with dizziness, nausea and generalised weakness and bilateral ptosis about 1 hour post-ingestion. C. filiformis is generally regarded as non-toxic and it does not contain gelsemium alkaloids. The exact origin of the gelsemium was not known in this case. This case highlighted the potential public health threat posed by the practice of picking and consumption of wild plants. Emergency physicians should also be aware that the plant species reported by the patients may not always be the ones causing clinical toxicities. (Hong Kong j.emerg.med. 2015;22:60-63)

Clinical manifestations and causes of gelsemium poisoning in Hong Kong from 2005 to 2017: Review of 33 cases

“…For cases presented early, gastrointestinal decontamination can be considered. The mortality in our study is 3%, which is comparable to other Chinese case series 15 …”

“…The mortality in our study is 3%, which is comparable to other Chinese case series. 15 Our study shares similar limitations as those in other retrospective chart reviews. As information abstracted was based on reviewing medical records and our database retrospectively, it was not possible for the authors to confirm or evaluate any aspect of the history or clinical findings.…”

“…More severe patients will also present with muscle weakness, respiratory depression and coma. Other clinical features uncommonly reported include liver and renal impairment, and cardiovascular symptoms 9,14 , 15 were essentially not seen in our case series, apart from high blood pressure and tachycardia, which was likely secondary to anxiety, and mild renal impairment (creatinine: 115 µmol/L) in only one patent.…”

“…More severe patients will also present with muscle weakness, respiratory depression and coma. Other clinical features uncommonly reported include liver and renal impairment, and cardiovascular symptoms 9,14 , 15 were essentially not seen in our case series, apart from high blood pressure and tachycardia, which was likely secondary to anxiety, and mild renal impairment (creatinine: 115 µmol/L) in only one patent. Different alkaloids have different actions, and many of them appear to have inhibitory effects on the respiratory centre in the medulla oblongata and anterior horn cells of the spinal cord, resulting in respiratory depression and muscle paralysis.…”

“…C. filiformis is a climbing, twinning, vine-like, non-toxic parasitic plant. Besides the close proximity of the growth of C. filiformis with G. elegans and their morphological similarities causing easy misidentification and contamination, 15 it was observed that C. filiformis parasitized on G. elegans could accumulate enough toxic gelsemium alkaloid from the latter to cause human poisoning upon consumption. 16 Besides those mentioned in our study, other benign herbs reported to be mixed up or contaminated with G. elegans include Sargentodoxa cuneata (大血藤), 2 Spatholobus suberectus Dunn.…”