POISONOUS PARTS
Whole plant, especially the flowers and seeds.3
TOXICITY
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Toxic Constituents
Cardiac glycosides such as convallatoxin, convalloside and convallarin; steroidal saponins such as convallasaponins.3,4
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Toxic Dose
2 sprigs of the plant can be toxic.5
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Mechanism
Cardiac glycosides inhibit Na+/K+-ATPase of the myocardium, increase its excitability and may lead to arrhythmias.6–8
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Poisoning Features
Because of the poor absorption of the cardiac glycosides in this plant, most exposures result in minimal toxicity. Occasionally, digitalis-like toxicity, including nausea, vomiting and arrhythmias, can occur.2,9
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Poisoning Events
Poisoning due to misidentification of the plant as edible species, or accidental ingestion of the red berries of the plant in children, have been reported in Milan, Berlin and Finland. However, the bitter taste of the berries discourages large consumption. The clinical features were usually mild and the patients generally recovered within 24 hours after supportive treatment.3,10,11
CLINICAL MANAGEMENT
Supportive treatment. Multiple-dose activated charcoal therapy has been used for gastrointestinal decontamination in cardiac glycoside poisoning, and digoxin-specific antibody has been used as an antidote.12,13
IDENTIFICATION FEATURES
Perennial herbs, 18–30 cm tall. Petioles 8–20 cm long; leaf blades 7–20 × 3–8.5 cm. Scapes 15–30 cm long, slightly curved; bracts 3–6 mm long; pedicels 0.6–1.5 cm long, slightly arcuate. Perianth white, 5–7 × 5–7 mm, lobes about 2 × 2 mm. Stamens about 4 mm long, anthers suboblong; styles 2.5–3 mm long. Berries 6–12 mm in diameter, red when ripe.14
MEDICINAL USES
Whole plant or roots used in TCM: warm yang and induce diuresis, strengthen heart, activate blood and dispel wind. Recommended dose: 3–6 g.2,15,16
LABORATORY ANALYSIS
Convallotoxin can be detected by LC-MS/MS.17
