Neuromuscular Blockade After Ingestion of Tree Tobacco (Nicotiana glauca)☆,☆☆,★
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INTRODUCTION
Tree tobacco (Nicotiana glauca) contains the alkaloid anabasine (C 10 H 14 N 2 ), an isomer of nicotine. This substance is responsible for the clinical toxicology and several documented deaths after the ingestion of the tree tobacco plant.1, 2, 3 We describe 2 separate patients who presented for evaluation and treatment after ingestion of the tree tobacco plant (N glauca). We also describe the constellation of signs and symptoms after ingestion of leaves from the tree tobacco plant.
Case 1
A 60-year-old white man presented to the emergency department with complaints of severe muscle weakness causing near-total paralysis. The patient had recently discovered an edible-appearing green leafy plant (Figure) growing in his garden. On the evening before admission, the patient consumed 10 to 12 leaves of the plant fried along with a steak dinner at approximately 7 PM . Within 5
DISCUSSION
Ingestion of commercial smoking tobacco is quite common, and the associated toxicology is well described.4, 5, 6 In severe cases, evidence of cholinergic excess is seen initially and neuromuscular blockade follows.7 A unique syndrome called “green tobacco sickness” occurs in young, inexperienced field workers with significant dermal exposure to the leaves of the green tobacco plant.8, 9, 10, 11 This is a milder form of nicotine toxicity associated with feeling seasick with nausea, vomiting,
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Cited by (29)
Fatal outcome following the application of Nicotiana Glauca.L. in the framework of the traditional pharmacopoeia
2022, Toxicologie Analytique et CliniqueCitation Excerpt :The pharmacokinetic characteristics of nicotine can be used to explain the toxicity of anabasine, as the chemical structures of these two compounds are quite similar. Thus, intoxication by nicotine and its alkaloid derivatives would proceed by a “partial agonist” activity on nicotinic acetylcholine receptors [11]. Anabasine induces a nicotino-cholinergic syndrome and the onset of symptoms is relatively rapid and can appear 2 h after ingestion of the leaves.
Respiratory Failure Due To Plant Poisoning: Nicotiana glauca Graham
2018, Journal of Emergency MedicineCitation Excerpt :Poisoning mostly occurs when the plant is mistaken for spinach and ingested. There is also a reported case of topical application of leaves as a folk remedy (4–10). Similarly, in our case, the patient had cooked and eaten the plant in the hopes that it would help cure her cancer.
Complex suicide with homemade nicotine patches
2014, Forensic Science InternationalModerate intoxication by Nicotiana glauca
2013, Presse MedicaleEffect of α<inf>7</inf> nicotinic acetylcholine receptor agonists and antagonists on motor function in mice
2013, Toxicology and Applied PharmacologyCitation Excerpt :Anabasine is considered a minor tobacco alkaloid, is found at low concentrations in tobacco (N. tabacum), and is thought to act synergistically with other tobacco alkaloids in facilitating smoking behavior (Clemens et al., 2009). Anabasine is the predominate piperidine alkaloid in tree tobacco (N. glauca), a plant that is often mistaken for wild spinach; its accidental consumption has been responsible for multiple fatalities in humans (Castorena et al., 1987; Deboer et al., 2009; Furer et al., 2011; Mellick et al., 1999; Mizrachi et al., 2000; Sims et al., 1999; Steenkamp et al., 2002). Nicotine and related piperidine and pyridine alkaloids initially stimulate nAChRs, but their persistence at their sites of action leads to receptor tachyphylaxis due to the majority of the receptors being in a desensitized state with a closed ion channel (Wang and Sun, 2005).
Piperidine alkaloids: Human and food animal teratogens
2012, Food and Chemical ToxicologyCitation Excerpt :The presence of anabasine (4) and anatabine in urine has been used as a biomarker of tobacco use (Jacob et al., 1999; Jacob et al., 2002). Anabasine (4) is the predominate piperidine alkaloid in tree tobacco (N. glauca), a plant that is often mistaken for wild spinach; its accidental consumption has been responsible for multiple fatalities in humans (Deboer et al., 2009; Castorena et al., 1987; Sims et al., 1999; Mellick et al., 1999; Mizrachi et al., 2000; Steenkamp et al., 2002; Furer et al., 2011). Anabasine (4) ingested in the form of dried ground tree tobacco produces MCC and cleft palate in calves, piglets, lambs and goat kids (Panter et al., 1990; Panter and Keeler, 1992; Keeler et al., 1984; Keeler and Crowe, 1984; Keeler et al., 1981b; Keeler and Crowe, 1983).
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Address for reprints: Larry B Mellick, MD, Medical College of Georgia, Department of Emergency Medicine, 1120 15th Street, AF-2036, Augusta, GA 30912-6811; 706-721-7144, fax 706-855-9797.
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