Question: Tox

C) Mistletoe ingestion can rarely lead to sloughing in the GI tract

Poinsettia plants, long thought to be toxic when ingested, are only local irritants, and cause only minor GI upset, nausea, and occasional vomiting. Since symptoms are so mild, observation at home with no ED visit is acceptable. Those with latex allergy, however, may cross-react, even to the point of anaphylaxis. There has only been one reported death, in 1919. There are 2 types of holly – English and American. The berries contain the toxin saponin; the leaves are not toxic. Toxic symptoms after ingestion are uncommon, and include nausea, vomiting, abdominal cramping, dermatitis, drowsiness and lethargy. Mistletoe comes in 2 forms: American and European (found also in California). All parts of mistletoe plants are toxic, except the berries of the European variety. Symptoms may not start for several hours, and can include GI upset, sloughing and necrosis of the GI tract, and liver damage, but serious symptoms are not common. Jerusalem cherry, aka Christmas orange, is found in Hawaii and the Gulf Coast states. The fruit contain the toxin solanine, and ingestion can cause anti-cholinergic symptoms, GI upset; symptoms may not start for hours, and may persist for days. Reference: Evens & Stellpflug, West J Emerg Med 2012;13(6):538-542 10.5811/westjem.2012.8.12572