Hikers poisoned: Veratrum steroidal alkaloid toxicity following ingestion of foraged Veratrum parviflorum

Abstract

Introduction Steroidal alkaloids are found in plants of the genus Veratrum. Their toxicity manifests as gastrointestinal symptoms followed by a Bezold–Jarisch reflex: hypopnea, hypotension, and bradycardia. Some Veratrum steroidal alkaloids are also teratogens interfering with the hedgehog-2 signaling pathway, which causes cyclopsia and holoprosencephaly. We present a case of accidental poisoning from Veratrum parviflorum mistaken for the edible Allium tricoccum (ramps, wild leek). Case history A 27-year-old man and his 25-year-old wife presented to the emergency department with nausea, vomiting, hypotension, and bradycardia after foraging and ingesting plants that they believed to be a local native species of wild leek. Methods We collected and analyzed the implicated fresh plant material and both patients’ serum/plasma. We used liquid chromatography–mass spectroscopy and high-resolution electrospray ionization time of flight tandem mass spectrometry to extract and characterize steroidal alkaloids from the foraged plant and patients’ serum. Results Our V. parviflorum samples contained verazine, veratramine, veratridine, and cyclopamine. Discussion Steroidal alkaloids have been previously isolated from Veratrum viride and Veratrum album and toxicity has been reported mainly from V. album species. Conclusion V. parviflorum toxicity manifests with gastrointestinal and cardiac symptoms. Treatment is symptomatic and supportive as with previous case reports of toxicity with other Veratrum species.

Post-harvesting of Solanum paniculatum L. leaves. Part II: Antioxidant activity and chemical composition

“…Reduction in the alkaloid content in 'Jurubeba' leaves is important in cases where there is constant consumption of this species, since high toxicity resulting from this class of secondary metabolites has been reported (Hyacienth & Almeida, 2015;Anwar et al, 2018).…”

Human neuronal signaling and communication assays to assess functional neurotoxicity

“…Na V channels are essential for the onset of action potentials and thus are of critical importance for the neuronal electrical activity. An alteration of their function can lead to severe functional neurotoxicity, even with lethal consequences on the level of the organism (Lehane and Lewis 2000 ; Gaillard and Pepin 2001 ; Nicholson and Lewis 2006 ; Llewellyn 2009 ; Wiese et al 2010 ; Vilariño et al 2018 ; Anwar et al 2018 ). Na V channels couple to [Ca 2+ ] i indirectly by triggering cell depolarization, which in turn leads to the opening of voltage-dependent calcium channels and thus an influx of Ca 2+ into neurons (Vetter et al 2012 ; Mohammed et al 2017 ).…”

Veratrum parviflorum: An Underexplored Source for Bioactive Steroidal Alkaloids

“…parviflorum is identified in nature using defined morphological traits. The stem is slender and 2 to 5 feet tall [15,17]. A pseudostem is formed by the overlapping sheaths of the leaves, which are broad (2-4 inches wide), petiolate, obscurely plicate, and have a blue tint adaxially [7,16,18].…”

“…V. parviflorum is found in the southeastern regions of North America [15][16][17][18]20]. This species grows in rich deciduous forests (800-2030 m) in the mid-Appalachians, including parts of Alabama, Georgia, Kentucky, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia [15,16].…”

“…parviflorum is found in the southeastern regions of North America [15][16][17][18]20]. This species grows in rich deciduous forests (800-2030 m) in the mid-Appalachians, including parts of Alabama, Georgia, Kentucky, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia [15,16]. The states of Alabama, Kentucky, and West Virginia have classified the conservation status of V. parviflorum as critically imperiled (S1), imperiled (S2), and vulnerable (S3), respectively [18,20].…”