12-08-2008 What is the Toxicity of Common Holiday Hazards

Question of the Week

December 8, 2008

We will once again initiate the Question of the Week.-only this time it will be new and improved (changed is the operative word).

The Tennessee Poison Center (TPC) now is supported by three Board-certified Medical Toxicologists.  John Benitez MD, MPH recently joined us in September 2008 from Rochester, NY.  He is Board-certified in Emergency Medicine, Preventive Medicine, Occupational and Environmental Medicine as well as Medical Toxicology.  Three years ago, Saralyn Williams MD joined us from San Diego, California and is Fellowship Director and Attending Toxicologist at the TPC.  She is Board-certified in Emergency Medicine and Medical Toxicology. 

All three of us will contribute to the Question of the Week.  If you have any subjects you would like to have addressed, please send me an email at donna.seger@vanderbilt.edu.

In keeping with the season, our first Question of the Week will address the Holiday Hazards.

WHAT IS THE TOXICITY OF COMMON HOLIDAY HAZARDS?

Christmas trees such as cedar, fir, and other popular evergreens are non-toxic.  All may cause dermal irritation or mechanical injury if ingested. 

Despite the common belief of toxicity, the Poinsettia is not a poisonous plant.  Poinsettia leaf ingestion should not cause any symptoms.  Playing with the leaves or rubbing the eyes after handling the plant may lead to local irritation.  Case reports of GI upset from Poinsettia ingestion generally involve animal cases or very large ingestions. 

The Christmas Cactus is non-poisonous.  The berries of American holly are considered low toxicity.  Ingestion of <5 berries should not produce any symptoms.  Ingestion of >5 berries may produce GI upset or mild drowsiness.  Mistletoe is a parasitic plant and there are many varieties.  Certain varieties contain substances that may cause cardiotoxicity and seizures.  The most common type distributed for re-sale in the United States is the phoradendron species, which causes cardiotoxicity and gastroenteritis.  TPC recommends wrapping fresh mistletoe in a fine netting before hanging it in the home.  This prevents leaves and berries from dropping to the ground and being ingested by young children.  Ingestion of >3 berries or >2 leaves is considered potentially toxic.

Christmas ornaments – an acute lick or taste of a painted ornament is not toxic even if the type of paint is unknown.  Many are made of thin metal, plastic, wood or glass and could cause a cut to the mouth or choking if ingested.

Christmas lights – most lights would only present a risk from the glass if a child bit into one.  Bubbling Christmas lights contain methylene chloride.  Methylene chloride is a skin irritant and if absorbed is metabolized to carbon monoxide.  The amount of methylene chloride in each light is typically <5ml and it is unlikely that a child could ingest enough liquid to cause toxicity.

Christmas tree preservatives – like other cut plant or flower preservatives, these substances are added to the water to prolong freshness of the tree. The primary ingredient is dextrose and they may contain VERY small quantities of fertilizers, potassium, magnesium, or fungicides.  All are considered non-toxic.

Spray snow (flocking) – non toxic when dried.  The propellant contains a fluorinated hydrocarbon and methylene chloride.  The main risk is from intentional “huffing” abuse of product.

Silver Balls (baking decoration) – commonly used on cakes and Christmas cookies as decoration.  The container lists in small print that these are not to be ingested.  The balls are coated with elemental silver.  Toxicity is not expected with typical ingestions.

TPC Toxicologists

Website: www.tnpoisoncenter.org