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ABSTRACT
A 2.5 yr old female beagle presented for acute abdominal pain and vomiting after consuming limited offerings of green potato
skins. Progressive complications associated with suspected ingestion of a higher potency toxin followed within 5 hr. Subse-
quent investigations revealed a signicant ingestion of an Australian shrub commonly called a Yesterday, Today, and
Tomorrow tree (Brunfelsia australis). The toxic principle for this emerging toxicity is referred to as strychnine-like and is
potentially lethal with gastrointestinal, central nervous system, and cardiac pathology. This plant is currently being aggres-
sively promoted by United States nurserymen for its dramatic tri-colored blooms and drought resistance. (J Am Anim Hosp
Assoc 2012; 48:139144. DOI 10.5326/JAAHA-MS-5725)
From the Sherman Oaks Veterinary Group, Sherman Oaks, CA. ASPCA American Society for Prevention of Cruelty to Animals; BP systolic
blood pressure; PO per os
Correspondence: clipsham@ucla.edu
blanketk was also applied, and a 2% lidocaine solutionl (60 mg/kg/min) Yesterday, Today, and Tomorrow Tree Poisoning
was administered to desensitize the myocardium. Subsequent elec- The genus Brunfelsia includes around 40 neotropical (New World
trocardiograms over the next 11 hr showed discontinuation of any south of the Tropic of Cancer) species, including shrubs, vines,
previous arrhythmias. and small trees originating from South and Central America,
Subsequent discussion with the owners revealed that the root Australia, Caribbean Islands, and southern Florida.1618 The
substances produced via the enema had prompted further in- common name is derived from the large, brightly star-shaped,
vestigation of their yard to dene alternate toxins beyond the colored owers with ve petals that change from deep blue to
suspect potato skins. Holes dug by the dog were found to contain lavender to white over time, giving the impression that three
chewed roots matching the size and character of those collected sets of blossoms are produced independently (Figure 2). Other
following the enema. The holes were located at the base of common names include: Morning, Noon, and Night Tree; Lady-
a Yesterday, Today, and Tomorrow tree (Brunfelsia australis). The of-the-Night; Paraguay Jasmine; Kiss-me-Quick; Cuban Raintree;
ingestion was estimated to be very recent due to daily inspection and Franciscan Raintree. The United States Department of Agri-
of the yard during oversight of family children. culture lists nine separate American species, apart from those
Symptomatic treatment of Solanum spp. toxicity was con- cultivated south of the United States and/or in Africa and Aus-
tinued, but as the nature and intensity progressed, the etiologic tralia.18 Indigenous nomenclature used by nurserymen further
diagnosis was quantitatively shifted from the potato ingestion to complicate accurate case etiology assignment and include:
the newly discovered B. australis source. Because of the overlap in Manac, Manacn, Chiric Sanango, Chuchuwasha, Manaka,
toxic principles, this case was therefore considered a compound Vegetable Mercury, Manag Caa, Gamb, Jeratacaca, Bloom
Solanum spp. toxicity. Brunfelsia spp. are members of the Sol- Of The Lent, Camgaba, Christmas Bloom, Chuchuwasha,
anaceae family and produce related glycoalkaloids in their owers, Gerataca, Geratacaca, Good Night, Jerataca, Moka Pari, Santa
roots, seeds, bark, leaves, and roots. The signs of toxicity mirror
those of the classic Solanaceae family, which includes potatoes.
The dog continued to recover in strength, coordination, and TABLE 1
mental capability over the following 24 hr, accompanied by an
Clinical Signs of Solanum/Brunfelsia Toxicity: General
increase in appetite and resolution of the diarrhea and associated Temporal Progression
hematochezia. The dog was discharged approximately 48 hr after Nausea
j Diarrhea6blood
the onset of the episode. A bland diet and sucralfate (0.5 gm PO q
8 hr 3 days) were prescribed for 48 hr to assist in gastrointestinal CNS depression/ headache
Vomiting
regeneration. The dog continued to improve the following day
Abdominal pain
and appeared in good condition on the scheduled follow-up ex- Cardiac arrhythmias
amination 2 wk after discharge. Mydriasis6hypothermia
Disorientation
Discussion Ataxia
Patients affected by Solanum spp. poisoning generally exhibit early Muscle tremors
Muscular paralysis6fever
systemic signs and clinically progress from gastrointestinal to
JAAHA.ORG 141
Medicine [October 2010]). The toxic principle is still referred to as
being strychnine-like. The litany and progression of clinical signs
are most likely due to the mlange of various suspect and known
toxic components, as seen in this case.
on these glycoalkaloids, but often renders toxin levels to a non- presented with yet another Brunfelsia poisoning within 2 wk
clinical level. Freeze drying and dehydration have no affect in re- subsequent to the dismissal of this specic case. Additionally, the
ducing active toxin levels. Alternative sources of Solanum toxicity author was informed by his wife during manuscript development
include drinking potato leaf tea, and potentially, the practice of that both a Yesterday, Today and Tomorrow tree and a related
using the boiled leaf and stem solution for pesticide spraying of Solanaceae family member, S. macranthum (Potato tree), had been
organic garden produce. However, potato leave tops are consumed purchased and were now residing in their back yard based on
as a vegetable source in Bangladeshi diets with no apparent dele- recommendations for hardiness.
terious affects. Chaconines are thought to be synergistic with so- Furthermore, this case is somewhat unique in that it is
lanine, but have been shown to possess a lower LD50 in mice when a combined Solanum poisoning, but with the majority of the toxic
administered separately.27 principle contributed by the Morning, Noon and Night Tree.
Clinically, potato poisoning cases have been treated symp- While the treatment here was relatively straightforward, rational,
tomatically similarly to Brunfelsia cases for their assumed com- and successful, the potential for a complex case of toxicity always
mon glycoalkaloid principles. Gross pathologic ndings are exists. A traditional poisonous substance was intensely com-
limited to gastrointestinal edema and hemorrhage without obvi- pounded by an emerging source of a related toxin, resulting in
24
ous neuropathology. Severe and nonresponsive cases in human a life-threatening toxicosis. When patients inappropriately ingest
patients have been successfully treated with physostigmine or one aberrant item, the probability of consuming a second toxic
7
pilocarpine. To date, no absolute subcellular, molecular mecha- item is inherently statistically elevated and compels consideration.
nisms have been assigned to either solanines or chaconines to This case is presented for practitioners to provide enhanced
account for their full range of clinical pathophysiologic actions information and therapeutic support due to limited data for which
in vivo. summaries or details are largely inaccessible by name and/or
completely unrecognized in many online databases and current
Conclusion and Clinical Relevance textbooks.
This case report is offered as an update to intoxication via ingestion
of B. australis (Yesterday, Today, and Tomorrow) and is one of The author wishes to acknowledge the clinical contributions of Dr.
several very limited reports available through the National Insti- Amanda Payne at the Animal Emergency Center, Studio City, CA,
tute of Health Pubmed database. The others reported as separate, in regard to this case presentation.
12,19
but related, species listed as B. pauciora and B. calcyina. The
patients signs and clinical progression were identical to those FOOTNOTES
a
reported in the small number of other dogs with exposure to Idexx Labs, Westbrook, ME
b
American Society for Prevention of Cruelty to Animals (ASPCA)
unidentied species, and one report in 1983 for B. australis.11 One
Poison Control Center; College of Veterinary Medicine, University
brief letter of a toxicity study referencing B. bonodora (in Australia of Illinois, Urbana, IL
in 1975) is also noted.10 Readily available information and ther- c
Normasol; Hospira, Inc., Saint-Laurent, Qubec, Canada
d
apeutic guidelines for practitioners for this toxicity were found to Zofran; GlaxoSmithKline, Research Triangle Park, NC
e
be scarce despite text reviews and numerous consultations with Atropine sulfate; Butler Schein Animal Health, Dublin, OH
f
toxicologists and veterinary specialists. Case in point is a fairly Pepcid; Merck, Whitehouse Station, NJ
g
Cerenia; Phizer, New York, NY
informative review available through the ASPCA poison control h
Buprenex; Reckitt Benckiser Group, plc, Slough, Berkshire, England
website, but was located only by using the search term for the i
Ampicillin; Sandoz Inc., Broomeld, CO
toxin brunfelsamide. This restricted identication terminology j
Carafate suspension; Axcan Scandipharm Inc., Birmingham, AL
and alternative name variations used for this group of Brunfelsia k
Bair Hugger; Airzant, Inc., Eden Prairie, MN
spp. (over 25), often incorrectly referenced as Brunsfelsia, can l
2% lidocaine; Sparhawk Laboratories, Inc., Lenexa, KS
result in case mismanagement.
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