{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T09:26:39Z","timestamp":1750325199796,"version":"3.38.0"},"reference-count":5,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Wilderness &amp; Environmental Medicine"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:p> Allium tricoccum (commonly known as \u201cramps\u201d) is an edible plant known for its strong garlic-like odor and onion flavor. Unfortunately, A tricoccum mimics such as Lily of the Valley ( Convallaria majalis) and False Hellebore ( Veratrum viride) can lead to foraging errors and subsequent patient harm\/toxicity. We describe 3 adults who foraged and ate what they believed were A tricoccum and then subsequently became symptomatic with detectable digoxin concentrations. A 41-y-old woman, 41-y-old man, and a 31-y-old man presented to the emergency department after ingesting an unknown plant that was believed to be A tricoccum. On arrival to the emergency department, the patients were hypotensive and bradycardic. They had detectable digoxin concentrations ranging from 0.08 ng\u00b7mL<jats:sup>-1<\/jats:sup> to 0.13 ng\u00b7mL<jats:sup>-1<\/jats:sup>. One patient received 20 vials of digoxin antibody fragments. All 3 patients recovered without complication. Laboratory analysis of plant specimen was positive for cyclopamine, a teratogenic alkaloid found in Veratrum californicum. A tricoccum foraging errors can be a source of morbidity given their similarity in appearance to plants like C majalis and V viride. C majalis causes a detectable digoxin concentration via its cardiac steroid compound (convallatoxin) that is similar to digoxin. V viride contains alkaloid compounds (such as veratridine) that can cross react with digoxin assays and lead to a falsely elevated digoxin concentration. Clinicians should be prompted to think about ingestion of C majalis or Veratrum spp. when patients present with bradycardia, gastrointestinal symptoms, and detectable digoxin concentrations after plant ingestion and\/or foraging for A tricoccum. <\/jats:p>","DOI":"10.1016\/j.wem.2022.04.008","type":"journal-article","created":{"date-parts":[[2022,6,9]],"date-time":"2022-06-09T21:04:17Z","timestamp":1654808657000},"page":"340-343","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Detectable Digoxin Concentrations in 3 Patients with Ramps Misadventure"],"prefix":"10.1177","volume":"33","author":[{"given":"Joshua","family":"Trebach","sequence":"first","affiliation":[{"name":"Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York"},{"name":"New York City Poison Control Center, Department of Health and Mental Hygiene, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Calleo","sequence":"additional","affiliation":[{"name":"Division of Medical Toxicology, SUNY Upstate Medical University; Upstate New York Poison Control Center, Syracuse, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Akbar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Westchester Medical Center, Valhalla, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Langston","sequence":"additional","affiliation":[{"name":"California Animal Health and Food Safety Laboratory, University of California at Davis, Davis, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Filigenzi","sequence":"additional","affiliation":[{"name":"California Animal Health and Food Safety Laboratory, University of California at Davis, Davis, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert S.","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,9,1]]},"reference":[{"key":"bibr1-j.wem.2022.04.008","unstructured":"Hamel P.B., Chiltoskey M.U. eds. Cherokee Plants and Their Uses - A 400 Year History, Sylva, NC: Herald Publishing Co., 1975, 52."},{"key":"bibr2-j.wem.2022.04.008","unstructured":"Densmore F. Uses of Plants by the Chippewa Indians, SI-BAE Annual Report #44. 1928; 296, 346. Available at: https:\/\/www.biodiversitylibrary.org\/item\/151430#page\/11\/mode\/1up. Accessed April 20, 2022."},{"key":"bibr3-j.wem.2022.04.008","doi-asserted-by":"publisher","DOI":"10.3109\/15563651003733666"},{"key":"bibr4-j.wem.2022.04.008","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2018.1442007"},{"key":"bibr5-j.wem.2022.04.008","doi-asserted-by":"publisher","DOI":"10.1016\/0736-4679(90)90226-L"}],"container-title":["Wilderness &amp; Environmental Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1080603222000679?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1080603222000679?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1016\/j.wem.2022.04.008","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1016\/j.wem.2022.04.008","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1016\/j.wem.2022.04.008","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T03:08:08Z","timestamp":1741662488000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1016\/j.wem.2022.04.008"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9]]},"references-count":5,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2022,9]]}},"alternative-id":["10.1016\/j.wem.2022.04.008"],"URL":"https:\/\/doi.org\/10.1016\/j.wem.2022.04.008","relation":{},"ISSN":["1080-6032","1545-1534"],"issn-type":[{"type":"print","value":"1080-6032"},{"type":"electronic","value":"1545-1534"}],"subject":[],"published":{"date-parts":[[2022,9]]}}}