Medical Toxicology of Natural Substances

Dr. Donald G. Barceloux is presently a Staff Physician in the Department of Emergency Medicine at Pomona Valley Community Hospital. He is also a teacher at UCLA, an active consultant on medical toxicology, and a fellow at the American Academy of Clinical Toxicology, American College of Medical Toxicology, and the American College of Emergency Medicine. In addition, he has written an array of papers and co-authored a medical toxicology reference book.

FOREWORD xv

PREFACE xvii

ACKNOWLEDGMENTS xix

REVIEW PANEL xxi

PART 1 FOODBORNE and MICROBIAL TOXINS 1

I Chemical Contamination and Additives 5
by Cyrus Rangan, MD, FAAP

1 Food Contamination 5

2 Food Additives and Sensitivities 22

II Staples and Spices 34

3 Akee Fruit and Jamaican Vomiting Sickness (Blighia sapida Köenig) 34

4 Cinnamon (Cinnamomum Species) 39

5 Cyanogenic Foods (Cassava, Fruit Kernels, and Cycad Seeds) 44

6 Cycad Seeds and Chronic Neurologic Disease (Cycas Species) 54

7 Djenkol Bean [Archidendron jiringa (Jack) I. C. Nielsen] 59

8 Grass Pea and Neurolathyrism (Lathyrus sativus L.) 62

9 Nutmeg (Myristica fragrans Houtt.) 67

10 Pepper and Capsaicin (Capsicum and Piper Species) 71

11 Potatoes, Tomatoes, and Solanine Toxicity (Solanum tuberosum L., Solanum lycopersicum L.) 77

12 Rhubarb and Oxalosis (Rheum Species) 84

III Microbes 89

A Bacteria 89
by Cyrus Rangan, MD, FAAP

13 Bacillus cereus 89

14 Campylobacter jejuni 96

15 Clostridium botulinum (Botulism) 103

16 Clostridium perfringens 114

17 Escherichia coli 120

18 Listeria monocytogenes 133

19 Salmonella 141

20 Shigella Species (Shiga Enterotoxins) 150

21 Staphylococcus aureus 156

22 Streptococcus Species 162

23 Vibrio Species 167

24 Yersinia enterocolitica 174

B Other Microbes 181

25 Cyanobacteria 181

26 Protozoa and Intestinal Parasites 191

27 Gastrointestinal Viruses 202

IV Seafood 212

28 Amnesic Shellfi sh Poisoning and Domoic Acid 212

29 Azaspiracid Shellfi sh Poisoning and Azaspiracid Toxins 218

30 Diarrhetic Shellfi sh Poisoning and Okadaic Acid 222

31 Neurotoxic Shellfi sh Poisoning and Brevetoxins 227

32 Paralytic Shellfi sh Poisoning and Saxitoxins 231

33 Ciguatera Fish Poisoning and Ciguatoxins 238

34 Puffer Fish Poisoning and Tetrodotoxin 247

35 Red Whelk and Tetramine 253

36 Scombroid Fish, Scombrotoxin, and Histamine 256

PART 2 FUNGAL TOXINS 261

I Mushrooms 265

37 Amatoxin-Containing Mushrooms 265

38 False Morel and Gyromitrin Poisoning 285

39 Gastroenteritis-Producing Mushrooms 290

40 Inky Cap and Coprine Toxicity [Coprinus atramentarius (Bull.) Fr.] 294

41 Isoxazole-Containing Mushrooms and Pantherina Syndrome (Amanita muscaria, Amanita pantherina) 298

42 Muscarine-Containing Mushrooms and Muscarine Toxicity (Clitocybe and Inocybe Species) 303

43 Orellanine-Containing Mushrooms and Nephrotoxicity (Cortinarius Species) 307

44 Paxillus and Other Mushroom Syndromes 312

II Mycotoxins 317

45 Mycotoxins 317

PART 3 MEDICINAL HERBS and ESSENTIAL OILS 373

I Medicinal Herbs 377

46 Aloe Vera [Aloe vera (L.) Burm. f.] 377

47 Aristolochic Acid and Chinese Herb Nephropathy 382

48 Black Cohosh (Actaea racemosa L.) 388

49 Blue Cohosh [Caulophyllum thalictroides (L.) Michx.] 394

50 Borage (Borago offi cinalis L.) 397

51 Burdock Root (Arctium lappa L.) 400

52 Calamus (Acorus calamus L.) 403

53 Camphor (Cinnamomum camphora T. Nees & Eberm.) 407

54 Cascara (Frangula purshiana Cooper) 414

55 Cat’s Claw [Uncaria tomentosa (Willd. ex Schult.) DC.] 421

56 Chamomile [Chamomilla recutita (L.) Rauschert, Chamaemelum nobile L.] 425

57 Chaparral [Larrea tridentata (Sesse & Moc. ex DC.) Vail] 429

58 Chaste Tree (Vitex agnus-castus L.) 434

59 Clove and Eugenol [Syzygium aromaticum (L.) Merr. & L. M. Perry] 437

60 Colocynth [Citrullus colocynthis (L.) Schrad.] 443

61 Coltsfoot (Tussilago farfara L.) 446

62 Comfrey and Other Pyrrolizidine-Containing Plants 449

63 Cranberry (Vaccinium macrocarpon Aiton) 458

64 Dong Quai [Angelica sinensis (Oliv.) Diels] 461

65 Feverfew (Tanacetum parthenium Schultz Bip.) 465

66 Garlic (Allium sativum L.) 470

67 Germander (Teucrium chamaedrys L.) 477

68 Ginger (Zingiber offi cinale Roscoe) 482

69 Ginkgo Tree (Ginkgo biloba L.) 488

70 Ginseng 497

71 Goldenseal (Hydrastis canadensis L.) 504

72 Hawthorn (Crataegus Species) 510

73 Impila, Pine Thistle, and Atractyloside 514

74 Jin Bu Huan and Tetrahydropalmatine 518

75 Juniper (Juniper communis L.) 522

76 Kava (Piper methysticum Forster) 525

77 Lavender (Lavandula Species) 532

78 Licorice (Glycyrrhiza Species) 537

79 Ma Huang (Ephedra Alkaloids) 545

80 Milk Thistle [Silybum marianum (L.) Gaertner] 553

81 Passionfl ower (Passifl ora incarnata L.) 558

82 Pennyroyal and Pulegone (Mentha pulegium L.) 563

83 Purple Conefl ower and Other Echinacea Species 568

84 Rosemary (Rosmarinus offi cinalis L.) 574

85 Rue (Ruta graveolens L.) 579

86 Sassafras [Sassafras albidum (Nutt.) Nees] 582

87 Saw Palmetto [Serenoa repens (Bartram) J.K. Small] 586

88 Senna (Senna alexandrina P. Mill.) 591

89 Skullcap (Scutellaria laterifl ora L.) 596

90 St. John’s Wort (Hypericum perforatum L.) 600

91 Star Anise (Illicium verum Hook. F. and Illicium anisatum L.) 607

92 Star Fruit (Averrhoa carambola L.) 611

93 Tansy (Tanacetum vulgare L.) 614

94 Valerian (Valeriana offi cinalis L.) 617

95 Yarrow (Achillea millefolium L.) 623

96 Yohimbe Bark and Yohimbine (Pausinystalia yohimbe Pierre ex Beille) 627

II Essential Oils 632

97 Citronella Oil [Cymbopogon nardus (L.) Rendle] 632

98 Citrus Oil and Limonene 635

99 Eucalyptus Oil (Eucalyptus Species) 644

100 Neem Oil (Margosa Oil) (Azadirachta indica Adr. Juss.) 648

101 Peppermint Oil (Mentha x piperita L.) 653

102 Tea Tree Oil (Melaleuca Species) 658

103 Tung Oil (Aleurites fordii Hemsl.) 663

104 Turpentine and Pine Oil (Pinus Species) 666

PART 4 TOXIC PLANTS 673

I Plant Dermatitis 677

105 Plant Dermatitis 677

II Bulbs, Rhizomes, and Tubers 690

106 Buttercup Family 690

107 Colchicine-Containing Plants 693

108 Daffodils and Other Emetic Bulbs 703

109 Death Camas 707

110 Kaffir Lily [Clivia miniata (Lindley) Bosse] 710

111 Snowdrop (Galanthus nivalis L.) 712

112 Zephyr Lily (Zephyranthes Species) 716

III Beans 718

113 Castor Bean and Ricin (Ricinus communis L.) 718

114 Cowitch and Horse Eye Bean (Mucuna Species) 727

115 Jequirity Bean and Abrin (Abrus precatorius L.) 729

116 Mescal Bean [Sophora secundifl ora (Ortega) Lagasca ex DC.] 733

IV Nonwoody Plants (Herbs) 736

117 Aconite Poisoning and Monkshood 736

118 African Blue Lily (Agapanthus Species) 743

119 Red Baneberry [Actaea rubra (Aiton) Willd.] 745

120 Begonias 747

121 Yellow Bird-of-Paradise [Caesalpinia gilliesii (Hook.) Wallich ex D. Dietr.] 749

122 Century Plant (Agave americana L.) 751

123 Cleistanthin, Diterpene Esters, and the Spurge Family (Euphorbiaceae) 754

124 Cyanogenic Plants and Laetrile® 760

125 Dieffenbachia and Other Oxalate-Containing House Plants 768

126 Digitalis-Containing Flowers (Foxglove, Lily of the Valley) 773

127 Jimson Weed and Other Belladonna Alkaloids 776

128 Lupines and False Lupine 784

129 Mayapple (Podophyllum peltatum L.) 788

130 Mistletoe 792

131 Poison Hemlock (Conium maculatum L.) 796

132 Pokeweed (Phytolacca americana L.) 800

133 European Bittersweet and Other Solanum Species 803

134 Sweet Pea and Osteolathyrism 806

135 Tree Tobacco and Other Piperidine-Containing Plants 809

136 Veratrum Alkaloids 815

137 Wandering Jew (Tradescantia fl uminensis Vellozo) 819

138 Water Hemlock and Water Dropwort 821

139 White Snakeroot [Ageratina altissima (L.) King & H.E. Robins] 826

V Shrubs and Vines 829

140 Barbados Nut (Jatropha curcas L.) 829

141 Boxwood (Buxus sempervirens L.) 832

142 Buckthorn [Karwinskia humboldtiana (J.A. Schultes) Zucc.] 834

143 Cactus 837

144 Carolina Jessamine [Gelsemium sempervirens (L.) St. Hil.] 841

145 Daphne (Daphne mezereum L.) 843

146 Dog Laurel (Leucothoe Species) 845

147 Dogbane Family and Cardenolides 847

148 Holly (Ilex Species) 861

149 Honeysuckle (Lonicera Species) 863

150 Ivy and Falcarinol 865

151 Lantana (Lantana camara L.) 867

152 Rhododendrons and Grayanotoxins 870

153 Snowberry [Symphoricarpos albus (L.) Blake)] 874

154 Squirting Cucumber [Ecballium elaterium (L.) A. Richard] 876

155 Wisteria 879

VI Trees 881

156 Black Locust (Robinia pseudoacacia L.) 881

157 Buckeye (Aesculus Species) 883

158 Chinaberry (Melia azedarach L.) 886

159 Golden Chain Tree (Laburnum anagyroides Medikus) 889

160 Karaka Nut (Corynocarpus laevigatus J.R. & G. Forst.) 892

161 Oaks (Quercus Species) 894

162 Pepper Tree (Schinus Species) 897

163 Yew (Taxus Species) 899

PART 5 VENOMOUS ANIMALS 905

I Arthropods 909

A Arachnids 909

164 Mites and Ticks (Order: Acari) 909

165 Scorpions (Order: Scorpiones) 914

166 Spiders (Order: Araneae) 925

B Centipedes 950

167 Centipedes (Subclass: Chilopoda) 950

C Insects 954

168 Bees, Wasps, and Ants (Order: Hymenoptera) 954

169 Bugs and Blister Beetles 969

170 Fleas (Order: Siphonaptera) 976

171 Flies and Mosquitoes (Order: Diptera) 979

172 Lice (Order: Phthiraptera) 983

173 Moths and Butterflies (Order: Lepidoptera) 988

II Reptiles 996

174 Amphibians—Toads, Frogs, Salamanders, and Newts (Class: Amphibia) 996

175 Gila Monster and Beaded Lizard 1008

176 Terrestrial Snakes (Suborder: Serpentes) 1013

177 Sea Snakes 1074

III Marine Invertebrates 1078

178 Cone Shells and Blue-Ringed Octopus (Phylum: Mollusca) 1078

179 Jellyfish, Hydroids, Sea Anemones, and Corals (Phylum: Cnidaria) 1085

180 Sponges (Phylum: Porifera) 1102

181 Starfish, Sea Urchins, Sea Cucumbers, and Fireworms (Phylum: Echinodermata) 1105

IV Eels and Lampreys 1112

182 Moray Eel (Superclass: Agnatha) 1112

V Fish 1115

183 Bony Fish (Class: Osteichthyes) 1115

184 Cartilaginous Fish (Class: Chondrichthyes) 1128

VI Mammals 1132

185 Mammals 1132

INDEX 1135