Acute death Camas (Toxicoscordion venenosum) plant poisoning in seven family members following foraging for wild onions

Abstract

Background: Unintentional plant ingestions and poisoning are common. Generally, these ingestions are asymptomatic or minimally symptomatic. Increased toxicity is often associated with the foraging for plants incorrectly identified as edible plants. We present a case series of seven family members poisoned by suspected Death Camas, also known as Meadow Death Camas, (Toxicoscordion venenosum), when the plant was misidentified as edible while foraging for Wild Onion (Allium canadense).

Case series: Five children and two adults presented to the emergency department after eating bulbs of suspected Death Camas (Toxicoscordion venenosum). Symptoms began within 30 to 60 min including nausea, vomiting, and abdominal pain. This was followed by bradycardia and hypotension consistent with Death Camas poisoning from alpha blockade, sodium channel activation, and increased vagal activity from the toxins. All of the patients required admission to the intensive care unit. Six patients were treated with supportive care alone and two patients required vasopressor support. An 89-year-old female developed a wide complex tachycardia and was treated with amiodarone. All patients had resolution of toxicity within 24 h and were discharged to home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Foodborne illness is a common presentation highlighted by signs and symptoms manifesting in multiple people eating the same meal. The misidentification of toxic plants as edible is associated with acute onset of signs and symptoms of toxicity. The toxins associated with Death Camas (Toxicoscordion venenosum), commonly thought to be edible Wild Onion (Allium canadense), are unique as these can cause gastrointestinal effects (e.g., nausea, vomiting, diarrhea), and cardiovascular effects (e.g., bradycardia, hypotension), which are often refractory to supportive therapy alone (e.g., crystalloid fluids), and can require atropine and vasopressors.

Keywords: Death Camas; Foraging; Plant poisoning.