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Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Thursday 29th December 2011 

When I first wrote about the American Association of Poison Control Centers (AAPCC) 2010 Annual Report of the National Poison Data System (NPDS) I noted that of the two deaths attributed to plants one was stated as being due to Allium sativum, garlic.

Since garlic is not something many people would think of as a lethal poison, I’ve been trying to find out more information about the case.

Euphorbia pulcherrima, poinsettia

Euphorbia pulcherrima, poinsettia

The NPDS report says that the victim was a 50-year old female who suffered acute poisoning after ingesting Allium sativum. The cause was given as ‘unintentional misuse’ and alcohol was reported as a secondary substance. The NPDS uses a 1 to 3 scale for ‘Relative Contribution to Fatality’ and this case was ranked as ‘2’ meaning that the garlic and alcohol were ‘Probably Responsible’ for the death.

As we know from Euphorbia pulcherrima, poinsettia, where its extremely harmful reputation is based on one alleged fatality from the early years of the 20th century, hysteria often surrounds a fatal plant poisoning and, especially with something consumed by many millions of people like garlic, you would think this case would have been widely reported. This seems not to have been the case. There is no record in the Google News archives and there don’t seem to have been any scientific papers reporting this case.

I searched the PubMed archive and found a case report from 2009 about a 52-year old male who suffered loss of consciousness after eating food with a garlic sauce. His problem was defined as an allergic reaction rather than poisoning. It’s worth mentioning, however, because it demonstrates how unusual it is for there to be no published case report of the incident noted by the NPDS. It should also be said that there appears to be no reports of the other plant death, attributed to Brugmansia suaveolens (syn Datura suavelolens).

Brugmansia suaveolens (syn Datura suavelolens)

Brugmansia suaveolens (syn Datura suavelolens)

There is a further complication. The Table 22A analysis by sub-categories attributes both the two deaths in the plant category to ‘Anticholinergics’. Whilst the angel’s trumpet given as the cause of the other fatality is certainly in that class, I haven’t come across any suggestion that Allium sativum fits that description.

It is known that garlic increases the risk of bleeding and that people taking anticoagulant drugs should be careful with it but, with no further detail, to be found it is impossible to say if the woman in this case was taking any such medication. The death is shown as being due to acute poisoning, that is a single large intake rather than a slow accumulation (chronic poisoning) so there has to be the possibility that this woman thought that a large dose of garlic would provide some sort of health benefit. The involvement of alcohol may, of course, have affected her judgement.

With so few fatal plant poisonings, and I’m not suggesting I should be pleased if there were more, it is frustrating that so little detail can be found about those that do occur.