Department of Emergency Medicine, Division of Medical Toxicology, University of Virginia, Charlottesville, VA 22908-0774, USA.
Clin Toxicol (Phila). 2010 Jun;48(5):435-42. doi: 10.3109/15563651003733666.
We report a case of digoxin-like toxicity because of ingestion of foraged plants. This patient presented with nausea, vomiting, bradycardia, and hypotension after ingesting Veratrum viride (false hellebore). The patient's serum specimen demonstrated a positive digoxin level (0.38 ng/mL) measured by a clinical tubidimetric immunoassay. We hypothesize that steroidal alkaloid compounds contained in V. viride cross-react with the Multigent Digoxin immunoassay reagent antibodies.
Plant extracts from V. viride demonstrated cross-reactivity to Multigent reagent antibodies but did not bind therapeutic DigiFab antibodies. Gas chromatography/mass spectrometry analyses identified several steroidal alkaloid compounds present in the V. viride extracts: jervine, ribigirvine, solanidine, and veratraman.
This study indicates that compounds extracted from V. viride can cross-react with a clinical Digoxin immunoassay. Yet these extracts did not bind DigiFab antibody fragments used for therapeutic intervention. Providers should not unnecessarily administer DigiFab fragments as an antidote in symptomatic V. viride toxic patients.
我们报告了一例因食用草药而引起的地高辛样毒性中毒病例。该患者在食用藜芦（白藜芦）后出现恶心、呕吐、心动过缓和低血压。患者的血清标本通过临床比浊免疫分析法检测出地高辛水平阳性（0.38ng/ml）。我们假设藜芦中所含的甾体生物碱化合物与 Multigent 地高辛免疫分析试剂抗体发生交叉反应。
藜芦植物提取物与 Multigent 试剂抗体发生交叉反应，但不与治疗性 DigiFab 抗体结合。气相色谱/质谱分析鉴定出藜芦提取物中存在几种甾体生物碱化合物：藜芦定、藜芦宁、茄碱和藜芦烷。
本研究表明，从藜芦中提取的化合物可以与临床地高辛免疫分析发生交叉反应。然而，这些提取物与用于治疗干预的 DigiFab 抗体片段不结合。在藜芦中毒症状患者中，临床医生不应不必要地给予 DigiFab 抗体片段作为解毒剂。
