Ingestion of false hellebore plants can cross-react with a digoxin clinical chemistry assay

Abstract

Introduction. 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. Results. 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. Conclusions. 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.

Keywords:

• Veratrum viride
• False hellebore
• Digoxin

Acknowledgments

This project was funded by the Lampe-Kunkle Memorial Award presented by the American Academy of Clinical Toxicology. GC/MS and LC/MSⁿ analyses were performed by JSP and reviewed by TRC. Funding for JSP, SAW, and TRC came from U90/CCU317014.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.