Neuromuscular Blockade After Ingestion of Tree Tobacco (Nicotiana glauca),☆☆,

https://doi.org/10.1016/S0196-0644(99)70280-5Get rights and content

Abstract

Two patients presented with life-threatening motor paresis after ingestion of leaves from the tree tobacco plant (Nicotiana glauca ). In addition to severe muscle weakness, bulbar palsies, flexor muscle spasm, hypertension, nausea, vomiting, and respiratory compromise were reported or observed. These are the fourth and fifth reported cases of a toxicologic emergency apparently caused by the alkaloid, anabasine, an isomer of nicotine found in the tobacco tree plant. The effects of this plant ingestion can mimic other better-known causes of paresis or paralysis. In areas of the country where the plant is indigenous, this toxicologic condition should be considered in the differential diagnosis of patients presenting with paresis or paralysis.[Mellick LB, Makowski T, Mellick GA, Borger R: Neuromuscular blockade after ingestion of tree tobacco (Nicotiana glauca ). Ann Emerg Med July 1999;34:101-104.]

Section snippets

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.

Figure. A tobacco tree plant (Nicotiana glauca) found growing in the garden by the patient described in Case 1.

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,

References (14)

  • SH Gehlbach et al.

    Nicotine absorption by workers harvesting green tobacco

    Lancet

    (1975)
  • Anonymous

    Child’s death laid to wild tobacco

    Los Angeles Times

    (June 10, 1962)
  • JL Castorena et al.

    Fatal poisoning from Nicotiana glauca

    J Toxicol Clin Toxicol

    (1987)
  • AS Manoguerra et al.

    Acute poisoning from the ingestion of Nicotiana glauca

    J Toxicol Clin Toxicol

    (1982)
  • E Malizia et al.

    Acute intoxication with nicotine alkaloids and cannabinoids in children from ingestion of cigarettes

    Hum Toxicol

    (1983)
  • BB Oberst et al.

    Acute nicotine poisoning

    Pediatrics

    (1953)
  • AK Armitage et al.

    Absorption and metabolism of nicotine from cigarettes

    BMJ

    (1975)
There are more references available in the full text version of this article.

Cited by (29)

  • Fatal outcome following the application of Nicotiana Glauca.L. in the framework of the traditional pharmacopoeia

    2022, Toxicologie Analytique et Clinique
    Citation 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 Medicine
    Citation 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 International
  • Effect of α<inf>7</inf> nicotinic acetylcholine receptor agonists and antagonists on motor function in mice

    2013, Toxicology and Applied Pharmacology
    Citation 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 Toxicology
    Citation 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).

View all citing articles on Scopus

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.

☆☆

0196-0644/99/$8.00 + 0

47/1/98147

View full text