A 39 y,o comes to the ED with nausea and vomiting after taking an herbal supplement
He was told it would help him quit smoking Hint: his pupils are dilated.
what did he take?
Our patient ingested lobelia inflata to assist with smoking cessation.
Lobelia was named in 1858 by Linnaeus to honor a Flemish botanist;, Mathias de L’Obel. It has been traditionally used in folk medicine to treat respiratory disorders. Lobelia inflata is known as Indian tobacco and it was found to contain a piperidine alkaloid, lobeline, which is a nicotine agonist interacting with nicotinic acetylcholine receptors in the nervous system..For this reason it has been used in smoking cessation. At higher doses it causes sweating nausea, vomiting, dilated pupils, tachycardia and seizures. Death has been reported from ingestion. Worldwide, it is used widely for asthma. 1 gm of leaf is thought to be toxic and 4 grams to be fatal.
the seed pod of lobelia has been found in the stomach of poisoned individuals
There are over 100,000 recorded plant ingestions in the US ear year with most of them in children. Deadly ingestions have been recorded throughout history.
SEVEN MOST COMMON DEADLY PLANTS
1. Water hemlock- killed Socrates. This is a large wildflower in the carrot family which can be confused with celery. It contains cicutoxin which causes abdominal pain and may cause death.
water hemlock
2. Deadly nightshade-(Atropa belladonna) contains atropine and scopolamine causing paralysis of involuntary muscles of the body. Macbeth’s soldiers poisoned the invading Danes with wine made from nightshade.
3. White snakeroot– contains a toxic alcohol known as tremetol. Abraham Lincoln’s mother died of ingesting milk from a cow which had been grazing in a pasture filled with snakeroot.
4. Castor bean-Castor beans are the source of castor oil but also contain ricin which is a deadly toxin. The hard outer shell of the bean prevents ricin from being absorbed and heat during the process of oil formation inactivates ricin.
5.Rosary Pea- is native to tropical areas and contains abrin, which is released if the seed is abraded. Reports of jewelry makers dying after pricking their finger with a needle that had gone through a seed.
6. Oleander -contains cardiac glycosides similar to digoxin which can cause vomiting, diarrhea and palpitations.
7. Tobacco- contains toxic alkaloids; nicotine and anabasine which can be fatal if eaten.
While less deadly, many plants, cause significant morbidity. Dieffenbachia, a common indoor plant, contains microscopic needle-like crystals in the leaves which cause irritation when a leaf is broken open. The most common way people, especially toddlers, are exposed to this plant is by biting into a leaf. Morman tea contains ephedra which acts as a stimulant.
FUN FACT
The first published case of a death associated with lobelia appeare in 1858 in the British Medical Journal. An autopsy was done on a 38 y,o. man who died suddenly. Seeds of Lobelia inflata were found in his stomach and other poisons were ruled out. It became a notorious case because his doctor was charged with murder but evidence was lacking that he actually prescribed lobelia and he was acquitted.
Bergner P. (1998). "Lobelia toxicity: A literature review". Medical Herbalism. 10 (1–2): 15–34.
Johnson H. Case of suspected poisoning by Lobelia inflata: the appearances after death. BMJ Vol1(77)June 19,1858:493-495.
Wright I, Littauer D. Lobeline sulfate its pharmacology and use in the treatment of tobacco habit. JAMA 1937;109:649-654.
Folquitto D, Swiech J, Pereira C, et al. Biological activity, phytochemistry and traditional uses of genus Lobelia (Campanulaceae): a systematic review. Fitoterapia Vol 134, April 2019:23-48.
Petruzzello, Melissa. "7 of the World’s Deadliest Plants". Encyclopedia Britannica, 4 Sep. 2025, https://www.britannica.com/story/7-of-the-worlds-deadliest-plants. Accessed 22 March 2026.