Hepatotoxic ornamental and houseplants

Question 1

Sago palm

Answer 1

-all parts of plant are toxic especially seeds
-seeds only in female plants
-tropical and subtropical regions
-generally toxic in dogs

Question 2

Sago palm mechanism and target

Answer 2

Target: liver, CNS, kidneys

Mechanism: methylation of DNA and RNA leads to inhibition of protein synthesis and ACUTE HEPATIC NECROSIS

Question 3

Toxin in sago palm

Answer 3

Mainly Cycasin which is bioactivated to methylazoxylmethanol (MAM) via beta-glucosidase

Question 4

Onset of sago palm toxicity

Answer 4

Within 15mins to several hours post ingestion

Question 5

Clinical signs of sago palm toxicity

Answer 5

-GI: vomiting, anorexia, diarrhea, hypersalivation

-Acute hepatic necrosis (icterus, ascites, ataxia, tremors, seizures, coma, increased liver enzymes)

Question 6

PM signs of sago palm toxicity

Answer 6

-GI hemorrhage and necrosis
-severe centrolobular hepatic necrosis with hydropic degeneration

Question 7

Management of sago palm toxicity

Answer 7

-no antidote
-GI decontamination and charcoal
-anti emetics, gastroprotectants, vit K, monitoring of liver enzymes

Question 8

Diagnosis of sago palm toxicity

Answer 8

-history of ingestion
-plant in vomitus

Question 9

Sago palm prognosis

Answer 9

Variable- mortality up to 67%

Poor indicators: thrombocytopenia, vomiting, lethargy, ALT, hypoalbuminemia

Improved prognosis: ALT less than 125 initially, treatment with activated charcoal