On August 26, 1983, eight people with acute gastrointestinal
and
neurologic symptoms were flown by helicopter to a Monterey,
California, hospital. Earlier that day, they had attended a
gathering
for 25 persons of a religious/philosophic group in a remote area of
Monterey County. Within 15 minutes after drinking refreshments, 11
persons began to have nausea and vomiting. The eight persons most
ill
reported nausea, vomiting, abdominal cramps, and weakness. Some
also
complained of dizziness and numbness; one was stuporous and was
hospitalized. Arterial blood gases were normal for all eight, as
were
serum cyanide levels (reported later). The San Francisco Bay Area
Regional Poison Control Center was promptly consulted regarding
treatment for possible cyanide poisoning, but specific treatment
was
not given because 4 hours had elapsed since exposure, blood gases
were
normal, and the patients were stable. All recovered quickly,
including the patient hospitalized overnight.
Investigation by the Monterey County Health Department revealed
that staff at the religious center had gathered local, wild
elderberries 2 days before the outbreak and had prepared juice from
them the next day. Bunches of berries were crushed with their
leaves
and branches in a stainless-steel press. Apple juice, water, and
sugar were added, and the mixture was stored overnight. The drink
was
served the next day in a stainless-steel pot to the group of 25
persons. Severity of illness correlated with the amount of
elderberry
juice consumed; those who drank only tea remained well. The
hospitalized person had consumed five glasses of the juice; the
others, much less.
Editorial Note
Editorial Note: The indigenous elder tree of the western United
States, Sambucus mexicana, can grow to 30 feet and produces small
(1/4-inch), globular, nearly black berries that can be covered with
a
white bloom at maturity. The berries are juicy and edible when
mature. The cooked berries are commonly eaten in pies and jams,
and
berry juice can be fermented into wine. The fresh leaves, flowers,
bark, young buds, and roots contain a bitter alkaloid and also a
glucoside that, under certain conditions, can produce hydrocyanic
acid. The amount of acid produced is usually greatest in young
leaves. There may be other toxic constituents in this plant. The
root is probably the most poisonous and may be responsible for
occasional pig deaths; cattle and sheep have died after eating
leaves
and young shoots.
Although a review of the medical literature revealed no other
reports of elderberry juice poisoning in the past 20 years, there
are
older, anecdotal reports of poisoning in children from the related
elder, S. canadensis. The religious center staff has been advised
that, while elderberries may be safe to consume, particularly if
cooked (uncooked berries may produce nausea), leaves and stems
should
not be crushed in when making juice.
Reported in California Morbidity (February 24, 1984) by S Kunitz,
MD,
RJ Melton, MD, T Updyke, Monterey County Health Dept, D Breedlove,
PhD, California Academy of Sciences, San Francisco, SB Werner, MD,
California State Dept of Health Svcs.
Bibliography
Casarett LJ, Doull J, eds. Toxicology: the basic science of
poisons. New York: Macmillan Publishing Company, 1975.
Kingsbury JM. Poisonous plants of the United States and Canada.
Englewood Cliffs, New Jersey: Prentice-Hall, 1964.
Millspaugh CF. American medicinal plants. New York: Dover
Publications, Inc.
Muenscher WC. Poisonous plants of the United States. New York:
Macmillan Company, 1951.
Osol A, Farrar GE. The Dispensatory of the United States of
America.
25th ed. Philadelphia: JB Lippincott Company, 1955.
Pammel LH. A manual of poisonous plants. Cedar Rapids, Iowa: The
Torch Press, 1911.
Disclaimer
All MMWR HTML documents published before January 1993 are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.
**Questions or messages regarding errors in formatting should be addressed to [email protected].
