Hikers poisoned: Veratrum steroidal alkaloid toxicity following ingestion of foraged Veratrum parviflorum

• Type of Material: Article
• Authors: Mehruba Anwar, Jackson Health System; Matthew Turner, Boise State University; Natalija Farrell, Boston Medical Center; Wendy B. Zomlefer, University of Georgia; Owen M. McDougal, Boise State University; Brent W Morgan, Emory University
• Language: English
• Date: 2018-01-01
• Publisher: Taylor & Francis: STM, Behavioural Science and Public Health Titles
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Informa UK Limited, trading as Taylor & Francis Group.
• Final Published Version (URL): http://dx.doi.org/10.1080/15563650.2018.1442007
• Title of Journal or Parent Work: Clinical Toxicology
• ISSN: 1556-3650
• Volume: 56
• Issue: 9
• Start Page: 841
• End Page: 845
• Grant/Funding Information: Support for graduate student Matthew W. Turner and seed funding for HPLC and MS for the project described was supported by Institutional Development Awards (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under Grants [#P20GM103408] (INBRE) and [P20GM109095] (COBRE in Matrix Biology).; Contents are solely the responsibility of the authors and do not necessarily represent the official views of NIH.; We also acknowledge support from the Biomolecular Research Center at Boise State with funding from the National Science Foundation [Grants # 0619793 and #0923535]; the MJ Murdock Charitable Trust; and the Idaho State Board of Education.
• Keywords: Life Sciences & Biomedicine; Veratrum; LAMBS; cyclopamine; Steroidal alkaloid; ALBUM; Science & Technology; Bezold-Jarisch; Toxicology; INTOXICATION; wild leeks
• Research Categories: Chemistry, Biochemistry; Chemistry, General; Health Sciences, Toxicology

Abstract

Introduction: Steroidal alkaloids are found in plants of the genus Veratrum. Their toxicity manifests as gastrointestinal symptoms followed by a Bezold–Jarisch reflex: hypopnea, hypotension, and bradycardia. Some Veratrum steroidal alkaloids are also teratogens interfering with the hedgehog-2 signaling pathway, which causes cyclopsia and holoprosencephaly. We present a case of accidental poisoning from Veratrum parviflorum mistaken for the edible Allium tricoccum (ramps, wild leek). Case history: A 27-year-old man and his 25-year-old wife presented to the emergency department with nausea, vomiting, hypotension, and bradycardia after foraging and ingesting plants that they believed to be a local native species of wild leek. Methods: We collected and analyzed the implicated fresh plant material and both patients’ serum/plasma. We used liquid chromatography–mass spectroscopy and high-resolution electrospray ionization time of flight tandem mass spectrometry to extract and characterize steroidal alkaloids from the foraged plant and patients’ serum. Results: Our V. parviflorum samples contained verazine, veratramine, veratridine, and cyclopamine. Discussion: Steroidal alkaloids have been previously isolated from Veratrum viride and Veratrum album and toxicity has been reported mainly from V. album species. Conclusion:V. parviflorum toxicity manifests with gastrointestinal and cardiac symptoms. Treatment is symptomatic and supportive as with previous case reports of toxicity with other Veratrum species.