Differential Diagnosis for Patient with Intake of Plants and Development of Sweats, Pallor, and Limb Weakness
Single Most Likely Diagnosis
- Plant-induced cholinergic toxicity: This is likely due to the ingestion of plants containing cholinergic toxins, such as those found in the Deadly Nightshade (Atropa belladonna) or Jimsonweed (Datura stramonium). Symptoms like sweats, pallor, and weakness are consistent with cholinergic excess.
Other Likely Diagnoses
- Nicotinic plant poisoning: Plants like tobacco (Nicotiana tabacum) contain nicotinic alkaloids that can cause symptoms similar to those described, including weakness, sweating, and pallor, due to nicotinic acetylcholine receptor stimulation.
- Anticholinergic plant poisoning: Although less likely given the symptoms, some plants can cause anticholinergic toxicity (e.g., Datura stramonium), which might present with a mix of symptoms including dryness, tachycardia, and in severe cases, delirium, but the presence of sweats and limb weakness might suggest a different primary effect.
- Cardioactive steroid plant poisoning: Plants containing cardioactive steroids (e.g., Digitalis purpurea) can cause symptoms like weakness, nausea, and changes in heart rhythm, which might indirectly lead to feelings of weakness and sweating.
Do Not Miss Diagnoses
- Taxine poisoning: Derived from yew plants (Taxus spp.), taxine can cause severe cardiac effects, including arrhythmias and heart block, leading to symptoms like weakness and potentially sweating and pallor. Missing this diagnosis could be fatal.
- Aconitine poisoning: Found in monk's hood (Aconitum spp.), aconitine can cause neurological, muscular, and cardiac symptoms, including numbness, weakness, and potentially life-threatening arrhythmias. The initial symptoms can be nonspecific, making it a critical diagnosis not to miss.
- Grayanotoxin poisoning: From rhododendron or azalea ingestion, grayanotoxin can cause vomiting, abdominal pain, and in more severe cases, neurological symptoms and cardiac effects, including weakness and potential for sweating and pallor.
Rare Diagnoses
- Cyclopeptide poisoning: Certain mushrooms contain cyclopeptides that can cause a range of symptoms, including gastrointestinal distress, followed by liver and kidney failure. Early symptoms might be nonspecific and could include sweating and weakness.
- Glycoside plant poisoning: Various plants contain glycosides that can have cardiac effects similar to digitalis, but the presentation might be rare and depends on the specific plant and amount ingested.