Background: The ingestion of potentially toxic substances may occur in individuals who prepare recipes containing novel ingredients posted on the Internet; similar exposures may occur after the consumption of innovative dishes available at progressive eateries. We present the case of a science teacher who had a therapeutic digoxin concentration after eating fried milkweed (Ascelpiadacea syriaca) prepared according to an online recipe.
Case Report: A 42-year-old male science teacher contacted the Poison Center after consuming 5 pods of fried milkweed for lunch. He prepared the milkweed according to a recipe he had discovered online while doing research for his class. After returning to work, a colleague alerted him to the possible dangers associated with consumption of the plant and he became alarmed. His only physical complaint at the time was nausea. He was referred to a healthcare facility and rode his bicycle there despite recommendations advising against this. In the Emergency Department, the patient's pulse was 40-50; however, he reported this was his baseline. His EKG showed sinus bradycardia without ST segment or T wave changes, and he had a measured serum digoxin concentration of 1.0 ng/mL 7.5 hours after the ingestion. His potassium was 4.2 mEq/L and serum creatinine was normal. As the patient was asymptomatic and hemodynamically stable, he was discharged to home.
Discussion: Previous case reports have described patients who developed acute toxicity, even death, following the ingestion of cardiac glycoside containing plants. Although this patient's symptoms were minimal, his measured digoxin concentration was elevated; this likely reflects cross-reactivity with other cardioactive steroids contained in milkweed. This case highlights the pitfalls of incomplete information available to the public on the Internet. In addition, a restaurant on the East Coast advertises the innovative use of milkweed in a featured seasonal dish.
Conclusion: Elevated digoxin concentrations, and potential toxicity, may occur in patients who consume milkweed. Inadvertent poisoning may occur due to recipes available on the internet and/or after consuming specialty dishes at restaurants.