Review Article

Medicinal Plants from North and Central America and the Caribbean Considered Toxic for Humans: The Other Side of the Coin

Table 2

Evaluation of causality and exclusion of alternate causes in clinical cases of medicinal plants from Mexico and Central America considered as toxic.

Information of the patient (age, gender, country of residence)Plant, way of administration, dose and part of the plant consumed, time of consumption if indicatedFirst symptoms (onset, in days, of the first symptoms)Toxic effects
(onset, in days, of the toxic effects)
Clinical complicationsEvaluation of causality (score)Amount of informationOutcome
(days)
Alternate causes excludedReference

9, M, Israel
Jatropha multifida Oral: >10 fruits
Vomiting, watery diarrhea, and abdominal pain (1 h)Gastroenteritis (1)Hepatic enzymes elevationNaranjo (5): probableEnoughRecovered (5)ND [43]
8, M, IsraelVomiting, watery diarrhea, and abdominal pain (1 h)Gastroenteritis (1)Hepatic enzymes elevationNaranjo (5): probableEnoughRecovered (5)ND

20 children;
8–13 years old, India
Jatropha curcas, Oral: 1–4 seeds1-2 hVomiting (95%)
Headache (40%) 
Fever (40%)
Diarrhea (50%)
NDRegularRecovered
(6 hours)
ND[57]

4, M, United States of AmericaConium maculatum (piperidina 850 Ug/g plant), NDDrowsiness (0.5 h)Central nervous system depression (3 hours)NDNaranjo (6): probableRegularRecovered (6)ND[58]

19, F, TurkeyConium maculatum, NDHeadache, blurred vision, and difficulty speaking (0.5 h)Central nervous system depression
(ND)
Difficulty breathingNaranjo (5): probableRegularRecovered (1)ND[59]

5, M, IndiaArgemone mexicana Oral: oilAbdominal pain, loos of movements and swelling throughout the body (20)Epidemic dropsy (ND)NDNaranjo (6):
Probable
RegularFatal (4)Thalassemia and sickle cell disease (postmortem) [60]
10, M, IndiaAbdominal pain, fever, and shortness of breath (20)NDNaranjo (6):
Probable
RegularFatal (11)Thalassemia and sickle cell disease (postmortem)

2, F, MexicoChenopodium ambrosioides, Oral: oil 80 ml (1,560 mg ascaridol)Vomiting and CNS depression (3 h)Multiple organ dysfunction syndrome (ND)Seizures, periods of apneaNaranjo (6): probableEnoughFatal (3)Encephalopathy due to lead poisoning and organophosphates[61]

64, F, United States of AmericaCimicifuga racemosa, Oral: capsules (80 mg/day/2 months)Painful nodules on her left foot (ND)Cutaneous vasculitis (42)NDNaranjo (5): ProbableRegularRecovered (90)ND [62]
54, F, United States of AmericaCimicifuga racemosa Oral: capsules (80 mg/day/4 months)Ulcers (ND)Cutaneous vasculitis (90)NDNaranjo (4): PossibleRegularRecovered (90)ND

57, F, United States of AmericaCimicifuga racemosa, Oral: capsules (without more specifications)Lethargy and fatigue (14)Autoimmune hepatitis (21)NDRUCAM (6)
probable (Hepatocellular)
Naranjo (7):
Probable
EnoughRecovered (14)Hepatic disease, serology of negative hepatitis, normal Antinuclear antibodies[63]

16, F, United States of AmericaPodophyllum peltatum Topical; 20% of the resin in tinctureVomiting, watery diarrhea, and abdominal pain (7 h)Multiple organ dysfunction syndrome (<1)Neurological toxicity and respiratory complicationsNaranjo (6): probableEnoughRecovered
(120)
ND[64]

18, F, United KingdomPodophyllum peltatum, Topical; 25% of the resin in tincture (7.5 ml = 1.88 g)NDHypokalemia and peripheral neuropathy (<1)Hypokalemia and peripheral neuropathyNaranjo (5): probableRegularRecovered
(90)
Previous cesarean anesthesia not discarded[65]

21, F, United States of AmericaCaulophyllum thalictroides, NDNDNicotinic toxicity (<1)Tachycardia, diaphoresis, abdominal pain, vomiting and muscle weaknessNaranjo (5): probablePoorRecovered
(1)
ND[66]

40, MThevetia peruviana Oral: seedsNDAtrioventricular block (1)Hyperkalemia, bradycardiaNaranjo (3): PossibleRegularRecovered (3)No cardiac history or vascular risk factor [67]
25, FCinchona pubescens Oral: leavesNDAtrioventricular block (1)bradycardiaNaranjo (3): PossibleRegularRecovered (2)ND
75, FCinchona pubescens Oral: infusionNDMultiple organ dysfunction syndrome (ND)NDNaranjo (3): PossiblePoorNDND

20 patients:
9–50 years old, Mexico
Metopium brownie, ND1–4Erythema (95%)
Vesicles (60%)
Papules (4%)
Blebs (2%)
NDRegularRecovered (ND)Poison ivy[68]

27, M, United States of AmericaLarrea tridentata, Oral: 500 capsules (3–7/day/10 months)Vomiting, watery diarrhea, and abdominal pain (ND)Hepatic damage (ND)NDNaranjo (4): Possible
RUCAM (4):
Possible (Hepatocellular)
RegularNDHepatic disease, serology of negative hepatitis, (cytomegalovirus positive, ingestion of other plants and history of alcohol abuse)[69]

13, M, Siri LankaAbrus precatorius Oral: 1 seedVomiting, watery diarrhea, and abdominal pain (5)Pulmonary edema associated with hypertension (1)Early renal parenchymal diseaseNaranjo (5): probableEnoughRecovered (3)Organophosphate poisoning, acute glomerular nephritis,
viral myocarditis, and dengue
[70]

17, F, IndiaAbrus precatorius, Oral: 10 seedsGastrointestinal (4)Idiopathic intracranial hypertension (6)Hepatic failure, hyponatremia, and hypokalemiaNaranjo (5):
Probable
EnoughRecovered (21)ND,
intentional intake
[71]
28, F, IndiaAbrus precatorius, Oral: 7 seedsGastrointestinal (20) Idiopathic
intracranial hypertension (4)
Seizures and respiratory failureNaranjo (5):
Probable
EnoughFatal (4)

18, M, United States of AmericaDatura inoxia, Oral: seedsIncoherences and hallucination (ND)Anticholinergic intoxication
(<1)
NDNaranjo (4): PossibleEnoughRecovered
(4)
Methamphetamine intake, and intake of other unknown substances[72]

Age is given in years old; ND, not described; F, female; M, male.