Journal of the Chinese Medical Association
Volume 73, Issue 2 , Pages 97-100, February 2010

An Outbreak of Foxglove Leaf Poisoning

  • Chun-Chi Lin

      Affiliations

    • Department of Medicine, National Yang-Ming University Hospital, I-Lan, Taipei, Taiwan, R.O.C.
    • ,
  • Chen-Chang Yang

      Affiliations

    • Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Department of Environmental and Occupational Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Dong-Haur Phua

      Affiliations

    • Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Emergency Department, Tan Tock Seng Hospital, Singapore
    • ,
  • Jou-Fang Deng

      Affiliations

    • Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Li-Hua Lu

      Affiliations

    • Emergency Department, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Li-Hua Lu, Emergency Department, Tungs' Taichung MetroHarbor Hospital, 699, Section 1, Chungchi Road, Wuchi, Taichung 435, Taiwan, R.O.C.

Received 28 April 2009; accepted 20 November 2009.

Article Outline

Comfrey (Symphytum officinale) leaves resemble those of foxglove (Digitalis purpurea) when the plant is not in bloom and, therefore, cardiac glycoside poisoning may occur when people confuse foxglove with comfrey. We report an outbreak of foxglove leaf poisoning following the use of alleged “comfrey” herbal tea. Nine patients were involved and initially presented with nausea, vomiting, diarrhea and dizziness. Significant cardiotoxicity developed later among the 3 patients who also had mild hyperkalemia. Peak serum digoxin concentration measured by immunoassay was elevated in all patients and ranged from 4.4 ng/mL to 139.5 ng/mL. Patients with severe cardiotoxicity were treated with temporary cardiac pacing. Moreover, 40–80 mg of digoxin-specific antibody therapy was given without any effect. All patients recovered uneventfully. Our report highlights the potential risk of misidentification of herbs; in this case, D. purpurea was mistaken for S. officinale. Physicians should be aware that cardiac glycoside poisoning could arise from such misidentification. Public education about the toxicity of D. purpurea poisoning may reduce the risk of misidentification and subsequent poisoning.

Key Words:  acute plant poisoning , cardiac glycoside , comfrey , Digitalis purpurea

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Kelly KL , Kimball BA , Johnston JJ . Quantitation of digitoxin, digoxin and their metabolites by high-performance liquid chromatography using pulsed amperometric detection . J Chromatogr A . 1995;711:289–295
  2. Rode D . Comfrey toxicity revisited . Trends Pharmacol Sci . 2002;23:497–499
  3. Bain RJ . Accidental digitalis poisoning due to drinking herbal tea . Br Med J (Clin Res Ed) . 1985;290:1624
  4. Porter R , Schultz D , Robertson WO . Alternative medicine toxicity: Digitalis poisoning! . J Toxicol Clin Toxicol . 1999;37:617
  5. Colls BM . A salutary lesson: three very unwise men . BMJ . 1999;318:1729
  6. Spain MM , Marraffa JM , Stroke CM . Toxicity after misidentification of foxglove for comfrey in the garden . Clin Toxicol . 2006;44:751
  7. Ramlakhan SL , Fletcher AK . It could have happened to Van Gogh: a case of fatal purple foxglove poisoning and review of the literature . Eur J Emerg Med . 2007;14:356–359
  8. Bismuth C , Gaultier M , Conso F , Efthymiou ML . Hyperkalemia in acute digitalis poisoning: prognostic significance and therapeutic implications . Clin Toxicol . 1973;6:153–162
  9. Lacassie E , Marquet P , Martin-Dupont S , Gaulier JM , Lachâtre G . A non-fatal case of intoxication with foxglove, documented by means of liquid chromatography-electrospray-mass spectrometry . J Forensic Sci . 2000;45:1154–1158
  10. Bateman DN . Digoxin-specific antibody fragments: how much and when? . Toxicol Rev . 2004;23:135–143

PII: S1726-4901(10)70009-5

doi:10.1016/S1726-4901(10)70009-5

Journal of the Chinese Medical Association
Volume 73, Issue 2 , Pages 97-100, February 2010

Article Tools