@article{ref1,
title="Detectable digoxin concentrations in 3 patients with ramps misadventure",
journal="Wilderness and environmental medicine",
year="2022",
author="Trebach, Joshua and Calleo, Vincent and Akbar, Sara and Langston, James and Filigenzi, Michael and Hoffman, Robert S.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="Allium tricoccum (commonly known as &quot;ramps&quot;) is an edible plant known for its strong garlic-like odor and onion flavor. Unfortunately, A tricoccum mimics such as Lily of the Valley (Convallaria majalis) and False Hellebore (Veratrum viride) can lead to foraging errors and subsequent patient harm/toxicity. We describe 3 adults who foraged and ate what they believed were A tricoccum and then subsequently became symptomatic with detectable digoxin concentrations. A 41-y-old woman, 41-y-old man, and a 31-y-old man presented to the emergency department after ingesting an unknown plant that was believed to be A tricoccum. On arrival to the emergency department, the patients were hypotensive and bradycardic. They had detectable digoxin concentrations ranging from 0.08 ng·mL(-1) to 0.13 ng·mL(-1). One patient received 20 vials of digoxin antibody fragments. All 3 patients recovered without complication. Laboratory analysis of plant specimen was positive for cyclopamine, a teratogenic alkaloid found in Veratrum californicum. A tricoccum foraging errors can be a source of morbidity given their similarity in appearance to plants like C majalis and V viride. C majalis causes a detectable digoxin concentration via its cardiac steroid compound (convallatoxin) that is similar to digoxin. V viride contains alkaloid compounds (such as veratridine) that can cross react with digoxin assays and lead to a falsely elevated digoxin concentration. Clinicians should be prompted to think about ingestion of C majalis or Veratrum spp. when patients present with bradycardia, gastrointestinal symptoms, and detectable digoxin concentrations after plant ingestion and/or foraging for A tricoccum.<p /> <p>Language: en</p>",
language="en",
issn="1080-6032",
doi="10.1016/j.wem.2022.04.008",
url="http://dx.doi.org/10.1016/j.wem.2022.04.008"
}