In beverages,
V. album has been mistaken for the harmless
yellow gentian (
Gentiana lutea) or wild garlic (
Allium ursinum), resulting in poisoning. All parts of the plant are poisonous.
Symptoms Symptoms of
Veratrum alkaloid poisoning typically occur within thirty minutes to four hours of ingestion, • vomiting • abdominal pain • hypotension •
bradycardia • nausea • drowsiness • dizziness • dilated pupils
Treatment Treatment for
Veratrum alkaloid poisoning include supportive care and symptomatic treatments, such as fluid replacement and
anti-emetics.
Atropine and
vasopressors act to combat bradycardia and hypotension. Duration of illness can last up to ten days but full recovery is possible within a few hours depending on dose and treatment. Sneezing powders are commonly used to prank others. In 1983, there were nine cases of accidental poisoning as a result of these pranks due to the presence of
Veratrum alkaloids in the sneezing powders. The victims were nine boys aged between 11 and 18 years old in
Scandinavian countries who used supplies imported from the
Federal Republic of Germany. All boys had inhaled the powder and six had ingested it. Symptoms typically presented within an hour, after which calls were made to authorities. After sneezing, the victims began to develop
gastrointestinal disturbances such as vomiting in all cases and
epigastric pain in two. Three of the children collapsed due to low blood pressure prior to being admitted to hospital. Seven of the children had significantly decreased blood pressure and five have cases of
sinus bradycardia with no other irregularities. Half of those who had ingested the powder were treated with
gastric lavage. Four of the boys were given atropine to combat bradycardia and one was given
activated charcoal. Atropine normalised their heart rates within minutes but did little to assist with low blood pressure. In all cases, the patients recovered within twenty-four hours. In 2009, eleven children, aged 8 to 12 years old, accidentally ingested
Veratrum album at a youth camp where they had prepared homemade tea using fresh herbs. Two children remained asymptomatic, nine developed mild gastrointestinal symptoms, six presented neurological symptoms, and three showed bradycardia; after medical care, all children recovered. Four cases of accidental poisoning were reported in 2010 after
Veratrum album was mistaken for
wild garlic and used in self prepared-salad and soups. A theory proposed by Schep in 2013 suggests that
Veratrum album was used to kill Alexander the Great. Schep argues that the usual suspects thought to be the culprit, such as
arsenic and
strychnine, would have acted too quickly to correlate with historical accounts. Alexander was ill for twelve days and suffered symptoms synonymous with
Veratrum album poisoning. Notably, the theory is furthered by the proposal that Alexander drank wine poisoned with
Veratrum album. Accounts from
Diodorus detail that the king was struck with pain after drinking a large bowl of unmixed wine in honor of
Hercules.
In vitro mechanism Veratrum album contains over fifty
steroidal alkaloids called
Veratrum alkaloids', including O-acetyljervine, cevadine,
cryptenamine,
cyclopamine (11-deoxojervine), cycloposine, germitrine, germidine,
jervine,
muldamine, protoveratrine (A&B),
veratramine,
veratridine, and veriloid. Some of the principal toxins have a modified steroid template while others differ in their esterified acid moieties. In general,
Veratrum alkaloids act by increasing the permeability of the
sodium channels of
nerve cells, causing them to fire continuously. Increased stimulation, associated with the
vagus nerve, results in the
Bezold-Jarisch reflex:
hypotension,
bradycardia and
apnoea. The alkaloids depolarize nerves by enhancing exchange of Na+ and K+ across the membrane. ==References==