taxine and Plant-Poisoning

Taxines are the active, poisonous constituents in yew plants (Taxus spp.) and can result in life-threatening cardiac toxicity. Rapid elimination of yew plant material and administration of active charcoal can limit absorption of toxins. Treatment is confined to supportive care. Therapeutic interventions such as utilization of digoxin immune fab, hemodialysis and temporary cardiac pacing may be utilized. Extracorporeal life support should be considered for severe cases.. Eine 45-jährige Patientin wurde nach suizidaler Taxin-Intoxikation heimatnah stationär aufgenommen. Im Rahmen der Erstversorgung wurde sie intubiert und bei hämodynamisch relevanten bradykarden Rhythmusstörungen mehrfach reanimiert. Vor Verlegung in unser Zentrum erfolgten noch eine Gastroskopie, die Anlage eines passageren Schrittmachers, die Gabe von Natriumbikarbonat sowie die Gabe von Digitalis-Fab.. Bei Übernahme war die Patientin tief sediert, intubiert, kontrolliert beatmet und hoch Katecholamin-pflichtig. Der körperliche Untersuchungsbefund und eine Röntgen-Thorax-Untersuchung waren unauffällig. Im Aufnahme-EKG fanden sich breite Kammerkomplexe. Echokardiografisch hatte die Patientin normal große Herzhöhlen mit global hochgradig reduzierter Funktion ohne Nachweis höhergradiger Klappenvitien.. Bei AV-Block Grad III und hochgradig eingeschränkter kardialer Funktion war die Therapie mit einer passageren Schrittmacheranlage allein nicht ausreichend, und es wurde zusätzlich mit Katecholaminen sowohl der Blutdruck stabilisiert wie auch positiv inotrop behandelt. Nach Verlegung kam es wiederholt zu ventrikulären Tachykardien, welche unter Amiodaron-Gaben sistierten. Nach 48-stündiger supportiver Therapie normalisierte sich die Herzfunktion. Die komplikationslose Extubation der Patientin war im Verlauf möglich und die Patientin konnte in eine psychiatrische Klinik zur weiteren Behandlung verlegt werden.. Taxin-Intoxikationen sind insbesondere kardiotoxisch. Die passagere Schrittmachertherapie trug zu einer Stabilisierung bei, eine Kreislaufunterstützung mit Katecholaminen war dennoch erforderlich. Wenn die genannten Maßnahmen nicht ausreichen, sollte eine Unterstützung durch eine extrakorporale Membranoxygenierung erwogen werden.

Topics: Alkaloids; Extracorporeal Membrane Oxygenation; Female; Heart Failure; Humans; Middle Aged; Plant Poisoning; Suicide, Attempted; Taxoids; Taxus

Common yew (Taxus baccata) is a common decorative evergreen shrub with potentially fatal toxicity hallmarked by seizure, arrhythmia and cardiovascular collapse if ingested. Taxine B has been identified as one of the most cardiotoxic taxine alkaloids in Taxus spp, and another alkaloid, 3,5-dimethoxyphenol (3,5-DMP), is used as a marker of ingestion. We present a fatal case of ingestion of yew with perimortem serum and gastric taxine B, and 3,5-DMP concentrations.. A 22-year-old woman was brought to the emergency department (ED) from a nearby botanical garden after she was found apneic and pulseless after a witnessed generalized tonic clonic seizure. The patient was found to have a wide complex rhythm with persistent cardiovascular collapse and expired despite maximal supportive care in the ED. A baggie of plant material was found on the patient, identified as Taxus baccata. Perimortem serum and gastric samples were analyzed to quantify serum and gastric taxine B and 3,5-DMP concentrations.. Perimortem serum showed a 3,5-DMP concentration of 86.9 ng/mL, and taxine B of 80.9 ug/mL.. We report a perimortem serum and gastric taxine B and 3,5-DMP concentrations in a fatal case of T. baccata toxicity.

Topics: Alkaloids; Emergency Service, Hospital; Fatal Outcome; Female; Humans; Phloroglucinol; Plant Poisoning; Seizures; Taxoids; Taxus; Young Adult

Twenty-six 5-month-old Holstein calves were accidentally exposed to discarded branches of yew bushes (Taxus sp.). Several calves were found dead approximately 24 hr after exposure; however, a few calves died several days after exposure. One calf died 18 days after the initial exposure to Taxus sp. and was examined on the farm via necropsy. Gross lesions included ascites, and dilated and flaccid myocardial ventricles. Sections of formalin-fixed heart were submitted to the Indiana Animal Disease Diagnostic Laboratory for histopathologic examination; fresh rumen contents were submitted for toxicologic testing. Histologically, large areas of myocardium were replaced by fibrous connective tissue, suggesting previous myocardial necrosis. Taxus alkaloids were identified in the rumen contents using gas chromatography-mass spectrometry. Based on the clinical history, the gross and histologic lesions, the identification of Taxus alkaloids in the rumen contents, and lack of exposure to other known cardiotoxic agents, yew toxicity was considered the cause of death in this calf. Ingestion of taxines is known to cause acute and subacute toxicity in human beings and animals; however, a chronic clinical course and severe histologic lesions have not been previously associated with yew toxicity. Although only 1 calf was examined, this case suggests that yew toxicity can result in a prolonged clinical course in cattle and can cause histologic myocardial lesions.

Topics: Alkaloids; Animals; Cardiomyopathies; Cattle; Cattle Diseases; Fatal Outcome; Female; Histocytochemistry; Plant Poisoning; Rumen; Taxoids; Taxus

Topics: Adolescent; Alkaloids; Electrocardiography; Humans; Male; Plant Poisoning; Renal Dialysis; Suicide, Attempted; Taxoids; Taxus

The yew tree (Taxus baccata) is an evergreen conifer that is widespread over central and southern Europe. The toxic effects of this conifer and its leaves have been known since ancient times. The seeds are generally responsible for accidental intoxications in childhood, whereas the bark and the leaves are mainly used for homicidal or suicidal attempts. We investigated the metabolic pattern of taxines in a healthy 44-year-old male farmer who was admitted to Bergamo Emergency Department after attempting suicide. High-performance liquid chromatography was used to separate and identify taxine metabolites. Data reported in this paper confirmed that the patient attempted suicide by ingesting Taxus baccata leaves, which had been suggested by clinical examination. The most abundant free and conjugated taxine metabolites were characterized. The high concentration of conjugated metabolites found in urine underscores the critical role that conjugation in the liver plays in eliminating taxines and increasing the probability of the patient's survival.

Topics: Adult; Alkaloids; Body Fluids; Eating; Humans; Male; Plant Leaves; Plant Poisoning; Poisons; Suicide, Attempted; Taxoids; Taxus

Common yew poisoning occurs by per oral application of needles or extracts of needles usually. The determination of the cause of death is more difficult in the latter case. In our article, we advise of circumstances which could be helpful in diagnostic. In addition, we describe the substances contained in yew, their effect, importance and toxicological detection.

Topics: Alkaloids; Humans; Male; Plant Poisoning; Suicide; Taxoids; Taxus; Young Adult

Yew (Taxus baccata) is a conifer known to be toxic since ancient times. Taxine A and taxine B, the toxic alkaloids of Taxus, block cardiac sodium and calcium channels causing nausea, vomiting, abdominal pain, cardiac arrhythmias, respiratory distress, coma, seizures, and death in yew poisoning.. A 44-year-old male farmer was admitted to the hospital because of a suspected myocardial infarction. First bradycardia and then ventricular tachycardia were present and a severe right ventricular dilatation with biventricular dysfunction was observed but with normal coronary arteriography. He was resistant to conventional therapy and, 6 h after hospital admission, extracorporeal support with membrane oxygenation was applied. The patient recovered. Nine days later, a large number of yew leaves were unexpectedly observed in his feces. Botanical and laboratory analysis confirmed the poisoning. Blood (651 ng/mL) and urinary (5.6 mcg/mL) levels of 3,5-dimethoxyphenol (metabolite of taxicatine) were greater than previously reported in lethal cases. The patient was transferred to a psychiatric unit 17 days after admission.. Intensive treatment of severe cardiovascular symptoms with antiarrhythmic drugs, temporary pacemaker, intra-aortic balloon pump, extracorporeal membrane oxygenation, and extracorporeal life support can be life-saving even after a potentially lethal ingestion of T. baccata leaves.

Topics: Adult; Alkaloids; Anti-Arrhythmia Agents; Bradycardia; Extracorporeal Membrane Oxygenation; Foodborne Diseases; Heart-Assist Devices; Humans; Male; Phloroglucinol; Plant Leaves; Plant Poisoning; Seizures; Tachycardia, Ventricular; Taxaceae; Taxoids; Taxus

A method is described for the analysis of taxine alkaloids by liquid chromatography/mass spectrometry. It is applicable to the detection of taxine alkaloids in the stomach contents of horses in which Taxus poisoning is suspected. Analysis of a leaf extract of Taxus baccata revealed unreported alkaloids of the same relative molecular mass as taxine B and isotaxine B.

Topics: Alkaloids; Animals; Chromatography, High Pressure Liquid; Gas Chromatography-Mass Spectrometry; Gastrointestinal Contents; Horse Diseases; Horses; Male; Plant Poisoning; Plants, Medicinal; Plants, Toxic; Taxoids; Taxus

Topics: Alkaloids; Animals; Cattle; Cattle Diseases; Gas Chromatography-Mass Spectrometry; Kentucky; Plant Extracts; Plant Poisoning; Solvents; Taxoids

The acute toxicity of taxine isolated from leaves of yew trees was determined in mice and rats. The drug was used as the sulphate salt. The following LD50 values (mg/kg) and 95% confidence limits were found: mice po 19.72 (16.84-23.09); mice ip 21.88 (19.66-24.35); rats sc 20.18 (18.35-22.20).

Topics: Alkaloids; Animals; Female; Lethal Dose 50; Male; Mice; Plant Extracts; Plant Poisoning; Rats; Taxoids

A case of fatal taxine poisoning from the ingestion of yew leaves by a young college man is reported. The toxicity of the plant is discussed, and the limited medical literature is reviewed.

Topics: Adult; Alkaloids; Cannabinoids; Chromatography, Gas; Gastrointestinal Contents; Humans; Male; Marijuana Abuse; Plant Extracts; Plant Poisoning; Plants, Toxic; Suicide; Taxoids

Topics: Alkaloids; Animals; Humans; Plant Poisoning; Plants, Toxic; Taxoids

Four prisoners drank a decoction of yew (Taxus baccata) needles containing the toxic alkaloid taxine++ B. Two died in prison (one in the cell, the other shortly after admission to prison hospital, death was caused in both cases by cardiac arrest). Two other prisoners were admitted to the Warsaw Poisons Control Centre. One of them was in deep coma, with severe ventricular arrhythmias and had several episodes of ventricular fibrillation controlled with defibrillatory procedures. After an initial improvement (return of consciousness) his general condition deteriorated suddenly, he lost consciousness again, his circulation stopped and he died on the fourth day of hospitalization. The other patient drank a much smaller amount of the decoction. He was conscious, had bradycardia requiring transient endocavitary pacemaking, and had mild ventricular arrhythmia. He left the hospital in a very good condition after ten days of treatment. In both these cases long-standing excessive diuresis and corresponding considerable hypokalemia were observed. A synergism of the toxic effects of taxine++ B, digitalis glycosides and hypokalemia is considered very likely. In both cases atropine was effective for a short time in the control of bradycardia.

Topics: Alkaloids; Critical Care; Humans; Male; Plant Extracts; Plant Poisoning; Plants, Toxic; Prisoners; Taxoids; Trees; Ventricular Fibrillation