(298) Death Camas or Wild Onions?

Introduction: Zygacine, the primary toxin in death camas, is a poisonous plant in western America. It is frequently reported to cause severe toxicity in cattle, including death. Human toxicity is rarely reported, and most frequently associated with accidental consumption as it resembles wild onions.

Description: Patient 1 was an 86 Y F with PMH of diabetes and hypertension, transferred to our hospital due to persistent hypotension, junctional bradycardia, nausea, and vomiting. She reported ingestion of wild onion 6 hours prior to presentation during family event. She had no pulmonary, genitourinary, or musculoskeletal complaints. Two hours after admission, cardiac rhythm changed to irregular tachycardia. MAP was < 60 requiring norepinephrine infusion for 8 hours. She received amiodarone for wide complex tachycardia. Troponin T was 36 ng/l and was flat on recheck. NT-Pro BNP was 1249 pg/ml. Other labs including renal and hepatic function were within normal limits. Echocardiogram showed normal biventricular function and no significant valvular disease. Gastrointestinal (GI) symptoms were treated with antiemetics. She was ultimately discharged home after one day of hospital stay.
Patient 2 was 59 Y M with no PMH who was in the same family event and reported the same ingestion of wild onion. He had nausea, vomiting, bradycardia and dizziness but didn’t have persistent hypotension. He had no other symptoms. He received supportive care and discharged home 20 hours later. Of note, five other younger family members had similar, but milder, symptoms and didn’t present to our facility.

Discussion: Zigadenus is a group of alkaline steroids that's thought to induce life threatening toxicity through activation of sodium and calcium channels. The method of ingestion doesn’t seem to affect toxicity, even when cooked in high temperature. This is the first case series reported in Arizona involving 7 family members. Cardiac toxicity was present in one patient, that could be a result of age, comorbidities, undiagnosed chronic cardiac illness, or amount of ingestion (which was unclear from history). GI symptoms were the most common cause of morbidity in our series. Poison control was consulted and recommended supportive care and treatment of dysrhythmias. All family members recovered to baseline within 24 hours.