Journal article
Detectable Digoxin Concentrations in 3 Patients with Ramps Misadventure
Wilderness & environmental medicine, Vol.33(3), p.340
06/09/2022
DOI: 10.1016/j.wem.2022.04.008
PMID: 35691768
Abstract
Allium tricoccum (commonly known as "ramps") is an edible plant known for its strong garlic-like odor and onion flavor. Unfortunately, A tricoccum mimics such as Lily of the Valley (Convallaria majalis) and False Hellebore (Veratrum viride) can lead to foraging errors and subsequent patient harm/toxicity. We describe 3 adults who foraged and ate what they believed were A tricoccum and then subsequently became symptomatic with detectable digoxin concentrations. A 41-y-old woman, 41-y-old man, and a 31-y-old man presented to the emergency department after ingesting an unknown plant that was believed to be A tricoccum. On arrival to the emergency department, the patients were hypotensive and bradycardic. They had detectable digoxin concentrations ranging from 0.08 ng·mL
to 0.13 ng·mL
. One patient received 20 vials of digoxin antibody fragments. All 3 patients recovered without complication. Laboratory analysis of plant specimen was positive for cyclopamine, a teratogenic alkaloid found in Veratrum californicum. A tricoccum foraging errors can be a source of morbidity given their similarity in appearance to plants like C majalis and V viride. C majalis causes a detectable digoxin concentration via its cardiac steroid compound (convallatoxin) that is similar to digoxin. V viride contains alkaloid compounds (such as veratridine) that can cross react with digoxin assays and lead to a falsely elevated digoxin concentration. Clinicians should be prompted to think about ingestion of C majalis or Veratrum spp. when patients present with bradycardia, gastrointestinal symptoms, and detectable digoxin concentrations after plant ingestion and/or foraging for A tricoccum.
Details
- Title: Subtitle
- Detectable Digoxin Concentrations in 3 Patients with Ramps Misadventure
- Creators
- Joshua Trebach - Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York; New York City Poison Control Center, Department of Health and Mental Hygiene, New York, New York. Electronic address: jtrebach@gmail.com.Vincent Calleo - SUNY Upstate Medical UniversitySara Akbar - Westchester Medical CenterJames Langston - University of California, DavisMichael Filigenzi - University of California, DavisRobert S Hoffman - Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York.
- Resource Type
- Journal article
- Publication Details
- Wilderness & environmental medicine, Vol.33(3), p.340
- DOI
- 10.1016/j.wem.2022.04.008
- PMID
- 35691768
- ISSN
- 1080-6032
- eISSN
- 1545-1534
- Language
- English
- Date published
- 06/09/2022
- Academic Unit
- Emergency Medicine
- Record Identifier
- 9984296967502771
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