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Toxic Landscaping of Facilities for Developmentally Disabled Adults

Anthony Burda, RPh, DABAT; Mark B. Mycyk, MD; Michael Wahl, MD; Charlotte Zia, BS, CHES
[+] Author Affiliations

Stephen J. Lurie, MD, PhDSenior Editor: IndividualAuthor
Jody W. Zylke, MDContributing Editor: IndividualAuthor

Copyright 2001 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

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JAMA. 2001;286(21):2671-2671. doi:10-1001/pubs.JAMA-ISSN-0098-7484-286-21-jlt1205
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To the Editor: Developmentally disabled adults are at a high risk for unintentional poisoning. Plant foliage surrounding residential facilities and day-training centers serving these adults may pose a significant potential poisoning hazard. During a 4-week period in August to September 2000, 4 unintentional plant poisonings of developmentally disabled adults, including 1 fatality, were reported to the Illinois Poison Center by such residential facilities.

REPORT OF CASES

A 45-year-old developmentally disabled man was found unresponsive 1 hour after he was seen eating twigs and plants. Prehospital telemetry demonstrated asystole, and he was pronounced dead in the emergency department. Postmortem examination revealed 300 mL of mulch, grass, twigs, and pine needles resembling those of the yew plant (Taxus spp) in his stomach, and no other apparent cause of death. Toxicologic analysis of the bile and blood confirmed the presence of alkaloids from the yew plant.

During this time, 3 other developmentally disabled adults, aged 20 to 50 years, were also admitted to emergency departments for plant ingestion. Two patients ingested leaves and berries from yew, while the third consumed honeysuckle berries. All were observed for 24 hours, and none had adverse effects.

COMMENT

Although plant ingestions represent the fourth most common call to poison centers, most ingestions are not associated with significant morbidity or mortality.1 3 However, 3 of these 4 cases involved the yew plant, a popular evergreen shrub containing toxic alkaloids that may cause sudden and potentially fatal cardiac toxicity.4 5 Developmentally disabled adults may ingest large amounts of plants and other potentially toxic substances. Based on these 4 cases, we suggest identification and removal of all toxic plants from areas surrounding facilities for developmentally disabled persons.

REFERENCES

Krenzelok  EP, Jacobsen  TD, Aronis  J. Those pesky berries . . . are they a source for concern? Vet Hum Toxicol. 1998;40:101-103.
Litowitz  TL, Klein-Schwartz  W, White  S.  et al.  2000 Annual Report of the American Association of Poison Control Centers toxic exposure surveillance system. Am J Emerg Med. 2001;19:337-395.
Krenzelok  EP, Jacobsen  TD, Aronis  J. Is the yew really poisonous to you? J Toxicol Clin Toxicol. 1998;36:219-223.
Mycyk  M, Burda  A, Tsoutsias  G.  et al.  A human fatality from "grazing" on a yew plant [abstract]. J Toxicol Clin Toxicol. 2001;39:550.
Van Ingen  G, Visser  R, Peltenburg  H, Van Der Ark  AM, Voortman  M. Sudden unexpected death due to Taxus poisoning: a report of five cases, with review of the literature. Forensic Sci Int. 1992;56:81-87.

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Krenzelok  EP, Jacobsen  TD, Aronis  J. Those pesky berries . . . are they a source for concern? Vet Hum Toxicol. 1998;40:101-103.
Litowitz  TL, Klein-Schwartz  W, White  S.  et al.  2000 Annual Report of the American Association of Poison Control Centers toxic exposure surveillance system. Am J Emerg Med. 2001;19:337-395.
Krenzelok  EP, Jacobsen  TD, Aronis  J. Is the yew really poisonous to you? J Toxicol Clin Toxicol. 1998;36:219-223.
Mycyk  M, Burda  A, Tsoutsias  G.  et al.  A human fatality from "grazing" on a yew plant [abstract]. J Toxicol Clin Toxicol. 2001;39:550.
Van Ingen  G, Visser  R, Peltenburg  H, Van Der Ark  AM, Voortman  M. Sudden unexpected death due to Taxus poisoning: a report of five cases, with review of the literature. Forensic Sci Int. 1992;56:81-87.
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