title: Friends and foes in the plant world: a profile of plant ingestions and fatalities.
abstract: BACKGROUND
  Plants are beneficial as foodstuffs and many have medicinal properties. However, some plants also have the potential to produce toxicity. The objective of this study was to characterize plant exposures that involve humans and to discuss those that are associated with morbidity and mortality, as well as some that have undeserved bad reputations.
  
  
  METHODS
  The American Association of Poison Control Centers (AAPCC) 1983-2009 annual reports were reviewed to identify all plant-related fatalities. The 2000-2009 AAPCC Toxic Exposure Surveillance System and the National Poison Data System databases were queried to identify all plant ingestions. The data were analyzed to identify the specific plants, the age and gender of those who were exposed, the reason for the exposures and patient outcome.
  
  
  RESULTS
  During the decade of 2000-2009, 668 111 plant ingestion exposures were reported, 621 109 were single substance exposures with no co-ingestants, and the age was known in 611 708 of the exposures. There has been a steady decline in the number of plant exposures reflected as a percentage of all exposures reported to US poison centers. A total of 8.9% of all exposures involved plants in 1983, 6.0% in 1990, 4.9% in 2000, and 2.4% in 2009. Males accounted for 52.2% of the ingestions and over 60% of the moderate and major outcomes occurred in males. Morbidity was related directly to the reason for the exposure with the most severe outcomes occurring in those who ingested plants intentionally for self-harm or substance abuse. Children ≤5 years of age accounted for 81.2% of plant ingestion exposures. Within this age category, there were 497 002 ingestions over the 10-year period where a known age was recorded and 57.8% occurred in children less than 1 year of age. Only 45 fatalities were recorded between 1983 and 2009. Datura and Cicuta species were responsible for 35.5% of the fatal outcomes.
  
  
  CONCLUSIONS
  Plant ingestion exposures remain a common call to poison information centers. However, the volume of those calls has decreased steadily over the last three decades. Most plant ingestion exposures occur in children, specifically children ≤5 years of age. Within this age group, there were an inordinate number of exposures in children <1 year of age, a previously unidentified finding with an unknown epidemiological basis. Morbidity and mortality associated with plant ingestion exposures were very low relative to the total number of reported exposures.
authors.affiliation: School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, USA. krenzelokep@upmc.edu
authors.forename: Edward P
authors.initials: EP
authors.lastname: Krenzelok
authors.forename: Rita
authors.initials: R
authors.lastname: Mrvos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010939:Plant Poisoning / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D010947:Plants, Toxic / Q000145:classification / Q000633:toxicity*; D011039:Poison Control Centers / Q000706:statistics & numerical data; D015996:Survival Rate; D055815:Young Adult