Featured Poison

Veratrum album: The Case of Mistaken Identity

People forage for wild foods, we’ve been doing it for tens of thousands of years, but it’s become a lost art. It’s easy to see why: we have supermarkets on every corner and if you don’t want to leave the house Uber can deliver meals to you. For people that still partake in foraging, either for sustenance, medicinal, or culinary reasons, mistakes do happen. The culprit is usually a case of mistaken identity, which I understand, as I frequently mix up the names of my twin girls, even though to my trained eye they look nothing alike. The downside to me mixing up a name is a glare and an exasperated “Daaad,” but mistaking one plant for another can have more severe, even fatal, consequences.

AmorogentinTake Gentiana lutea, commonly known as yellow gentian or bitter root, as an example. Growing up to 6 feet (2 meters) tall in the grassy, alpine regions of central and southern Europe, Gentiana has a long, long history of medicinal use for the treatment of digestive disorders and general “stomach ailments.” One of the chemicals responsible is the glycoside amorogentin, which, in a twist of irony because of the sugar moiety (glycoside), just so happens to be one of the most bitter substances known.* Amorogentin, as a digestive system cure-all, works on several fronts: the promotion of saliva and bile secretion (to break things down) and inhibiting gastric juice secretion and ramping up prostaglandins (anti-ulcer). (1, 2)

* Cocktail bitters, used to make your alcoholic beverage, well, bitter, are often made from Gentian root. For you teetotalers, you can get your fix from the iconic soft drink Moxie, the official soft drink of Maine, which is brewed with Gentian root. You’ll either love it or hate it.

With the long-standing medicinal properties of Gentiana root understood, it comes as no surprise that a German man collected the roots of what he believed to be Gentiana lutea and used it to make a fermented, alcoholic beverage. Later, he took about two shots of the 25% alcohol (50 proof) concoction, and shortly thereafter experienced nausea, vomiting, and a prickly “pins and needles” feeling in his mouth. On admission to the ED he was bradycardic and hypotensive – slow heart rate of 30 bpm and very low blood pressure of 50/30. Aside from detoxification with activated charcoal, he was given atropine to increase his heart rate and metoclopramide and ondansetron to control the nausea and vomiting. He was fortunate to receive prompt medical care, and completely recovered and was discharged 24 hrs later. (3)

Putting 2-and-2 together, from the clinical signs and symptoms coupled with excellent analysis of the fermented drink, led to the realization that our German fellow poisoned himself with tea made from Veratrum album. Commonly known as white or false hellebore, it is a perennial herb that, like gentian root, grows in alpine regions and produces flowery stems reaching 6 feet tall. The fact that they look a bit alike – particularly when young – led to our case of mistaken identity.

veratrum-album-and-gentiana-lutea.png

Left: Veratrum album by Kabachi (CC BY 2.0) Right: Gentiana lutea by Joan Simon (CC BY-SA 2.0)

The question we all have now is: what chemicals caused the nausea, vomiting, and cardiac issues? That would be a bunch of alkaloids found in white hellebore, but the ones detected and confirmed in the serum of our poisoned German were protoveratrine-A (ProA) and protoveratrine-B (ProB), at concentrations of 1162 and 402 ng/L, respectively. Did I mention that the analytical toxicology work done in this case was really good? (3)

Protoveratrine-A

Steroidal alkaloids ProA and ProB act on voltage-gated sodium channels – the same molecular targets as the Queen of Poisons aconitine and the Mad Honey grayanotoxins. Sodium channels are responsible for conducting electrical impulses throughout the body, they allow us to function. Once bound by ProA the conformation of these proteins changes, causing the ion channels to stay open longer as if it is in a constantly activated, open state. Affected sites are membranes of “excitable” cells and tissues, notably neurons, and skeletal and cardiac muscle. This is bad, with toxicity manifesting in several systems. Neurologically, there is that “pins and needles” feeling in the face mentioned earlier, called paresthesia, which can also occur in the limbs. On the cardiovascular side, we have hypotension, bradycardia, and a plethora of arrhythmias. Good old nausea, vomiting, and diarrhea round out the gastrointestinal system. Fun times, fun times.

So if you’re inclined to do some foraging, urban or otherwise, it’s always a good idea to get proper training and education, along with knowing what the common “lookalikes” are in your area, as well as being 100% sure of what you’re putting in your body. Personally? Foraging isn’t my thing, I get a lot more enjoyment out of trolling the twins by calling them the wrong names.

UPDATE: I added some “Toxic Tidbits” about Moxie and a 1982 outbreak of sneezing powder intoxications involving Veratrum album. Yes, sneezing powder. You can read all about it here: Moxie Original Elixir and Sneezing Powders.

** Feature image of Veratrum album by Andrea Schieber (CC BY-SA 2.0) **

References:

  1. Mirzaee, Fatemeh, Amirsaeed Hosseini, Hossein Bakhshi Jouybari, Ali Davoodi, and Mohammad Azadbakht. “Medicinal, Biological and Phytochemical Properties of Gentiana Species.” Journal of Traditional and Complementary Medicine 7.4 (2017): 400-08.
  2. Niiho, Yujiro, Takashi Yamazaki, Yoshijiro Nakajima, Toshinori Yamamoto, Hidehiro Ando, Yasuaki Hirai, Kazuo Toriizuka, and Yoshiteru Ida. “Gastroprotective Effects of Bitter Principles Isolated from Gentian Root and Swertia Herb on Experimentally-induced Gastric Lesions in Rats.” Journal of Natural Medicines 60.1 (2005): 82-88.
  3. Grobosch, T., T. Binscheck, F. Martens, and D. Lampe. “Accidental Intoxication with Veratrum Album.” Journal of Analytical Toxicology 32.9 (2008): 768-73.

 

3 thoughts on “Veratrum album: The Case of Mistaken Identity

  1. Justin, this is not a comment, as such it is more of a request for a look at a
    poison that I know little about.
    In the South American jungles there is sometimes a mass of fluffy white caterpillars in a tree or bush. Anyone who handles these will die 45 (or so) days later, no symptoms
    in the meantime!
    This is what I read once in a publication that I have forgotten.
    I can’t tell you more than this but it sounds interesting, no?

    Geoffrey Robertson

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