@article{ref1,
title="Hikers poisoned: Veratrum steroidal alkaloid toxicity following ingestion of foraged Veratrum parviflorum",
journal="Clinical toxicology (Philadelphia, Pa.)",
year="2018",
author="Anwar, Mehruba and Turner, Matthew and Farrell, Natalija and Zomlefer, Wendy B. and McDougal, Owen M. and Morgan, Brent W.",
volume="56",
number="9",
pages="841-845",
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. <br><br>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. <br><br>RESULTS: Our V. parviflorum samples contained verazine, veratramine, veratridine, and cyclopamine. <br><br>DISCUSSION: Steroidal alkaloids have been previously isolated from Veratrum viride and Veratrum album and toxicity has been reported mainly from V. album species. <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="1556-3650",
doi="10.1080/15563650.2018.1442007",
url="http://dx.doi.org/10.1080/15563650.2018.1442007"
}