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"Adverse Drug
Event of the month"
Adverse event reported by the Department of Pediatrics Misidentification of dumb cane as sugar cane and poisioning in a child. Introduction and case details During an intensive in-hospital adverse event monitoring in the department of pediatrics, a 5-year-old male child presented with alleged history of ingestion of stalk of a plant cultivated in the orthopedic center garden of the KEM hospital. The child misidentified the stalk as being sugarcane and consumed it out of curiosity. The patient presented with severe perioral itching and itching in the oral cavity. There were no other symptoms suggestive of systemic involvement. The patient's vital parameters were stable at examination. The patient was treated with stomach wash and other symptomatic treatment included antihistaminic and analgesics. Patient's symptoms improved gradually and he was discharged after three days of uneventful hospital stay. Discussion Poisoning in children is a common cause of admissions to the pediatric ward. During a retrospective analysis at National Poisoning Control Center, All India Institute Of Medical Sciences,New Delhi, 1.5% of all poisoning cases in children were attributed to plants. (1) Plant exposures are some of the most frequent poisoning cases reported to poison control centers worldwide. The plant consumed by the child in the present case was identified as an oxalate containing plant called Dumb Cane. Exposure to plants containing oxalate crystals like Philodendron and Dieffenbachia are among most common cause of poisoning due to toxic plants. (2) Dumb Cane belongs to Family- Araceae; Genus- Dieffenbachia. It is 3-10 feet tall and a common indoor tropical plant with large leaves usually mottled or variegated and yellow and green in colour. It is commonly known as Dumb cane, Tuftroot or Leopard lily. (3,4). This is a poisonous plant and all parts of the plant are poisonous. Over the past 200 years, irritant properties of Dieffenbachia have been used for punishing slaves, treating gout, erectile dysfunction and frigidity. Today they are admired for their ornamental properties and used in public places and homes. Nonsoluble calcium oxalate crystals are found in the plant stem, roots and leaves. The stalk of the plant produces the most severe reaction. These needle like crystals produce pain and edema when in contact with lips, tongue, oral mucosa, and conjunctiva and skin. Edema is primarily because of trauma due to needle like crystals and to a lesser extent by other plant toxins (eg.bradykinins)(2). Majority of oxalate plant exposure occurs in children below 5 years of age while handling houseplants. Depending open exposure to plant sap or juices symptoms may include keratoconjunctivitis and corneal abrasions, local skin erythema or edema. Erythema, edema, bulla and inflammation of mouth and oral mucosa-Severe throat burning make a person unable to speak and hence the name Dumb Cane. (3). Consumption of the plant can rarely lead to laryngeal edema and airway obstruction. Treatment includes decontamination of mouth, eye and skin by physically removing all plant products. Assessment for any airway obstruction, copious irrigation for eye and skin and use of antihistaminic and analgesics for pain relief are the treatment of choice. Individuals without airway obstruction can drink cold liquids and eat crushed ice, ice cream for pain relief. In most cases, exposure to oxalate containing plant produces self-limiting symptoms. Significant mortality and morbidity is extremely rare. Only one case report of an infant fatality attributed to airway obstruction after exposure to Dieffenbachia exists in literature. The inquisitive nature of children and easy accessibility to these type of indoor plants can expose children to the danger of poisoning. Hence in gardens naming and indicating that plant is poisonous forms an important part of preventive measures. These types of poisonous plants should be kept at a height, out of reach of children. Older children can be taught to recognize poisonous plants and avoid their handling. A little extra effort from parents and gardeners can prevent such accidents from happening. References |
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