Indian Apple Poisoning in Dogs

The Indian apple is a perennial plant found commonly in the woods, fields, and along roadsides all over the United States, most often in the southeast and midwestern states. The plant can grow up to 18 inches high and has umbrella type leaves shaped like shields with one large white cuplike flower. Each plant grows one yellow fruit, shaped like an egg that is sometimes eaten by humans when fully ripe. Although the podophyllotoxin found in Indian apple is sometimes used in herbal medicine for treatment of measles and viruses, it is not safe for consumption in any amount unless directed by a physician, and should never be given to pets of any kind.

Poisoning from Indian apple includes the consumption of any part of the plant and exposure to the roots due to a poisonous substance, podophyllotoxin, which is a podophyllum resin that stops cell division. This toxin is easily absorbed through the skin and can be fatal to your dog if eaten and absorbed at the same time, leading to a large amount of poison in the system. Some of the side effects from consuming or absorbing too much podophyllotoxin include contact dermatitis, gastrointestinal distress, and central nervous system depression. The caustic action caused by the Indian apple is not like other caustic reactions because it produces effects slowly from inside the tissue by disrupting cells. There have been some cases of kidney and liver failure due to high levels of serum concentrations (AST, LDH), but this is rare.

Symptoms of Indian apple poisoning (both ingestion and dermal) can be very different from one plant to another and may also affect certain breeds more than others. Many veterinary professionals believe toy dogs are more susceptible, but it is not clear whether this is due to their size or a specific breed. The signs of Indian apple poisoning most often reported are:

• Red, inflamed skin
• Skin ulcers
• Sore throat
• Abdominal pain
• Nausea
• Vomiting
• Diarrhea (sometimes severe)
• High body temperature
• Slowed reflexes
• Restlessness and nervousness
• Unsteady gait
• Confusion
• Muscle weakness
• Unusual bruising or bleeding
• Panting
• Low blood pressure
• Mouth sores
• Difficulty urinating
• Rapid heartbeat
• Labored breathing
• Drowsiness
• Seizures (rare)
• Coma (rare)
• Death (rare)

 Types

The Indian apple plant (podophyllum peltatum) is from the Berberidaceae family and is also known as:

• American mandrake
• Devil’s apple
• Duck's foot
• Hog apple
• Indian apple root
• May apple
• Peca
• Raccoon berry
• Umbrella leaf
• Vegetable mercury
• Wild lemon
• Yellow berry

The cause of Indian apple poisoning is the consumption or contact with the Indian apple plant. The toxic property, podophyllotoxin, is found throughout the entire plant, but mostly concentrated in the roots. Highly toxic, this plant can cause a myriad of serious effects, due to the disruption of cell tissue.

Diagnosing Indian apple poisoning is easier to do if you bring a photograph or sample of the plant for the veterinarian to see. In addition, the veterinarian will want to rule out other illnesses and diseases by doing a complete physical, images, and laboratory tests. If you can bring your pet’s medical and shot records, it may help with a treatment plan. However, if you do not have them, be sure to let the veterinarian know if your dog is on any medication or has any medical problems she needs to know about.

An examination of your dog’s ears, eyes, nose, and mouth, as well as the condition of the coat and skin, will be done to gauge your pet’s overall health. Body temperature, blood pressure, heart rate, and breath sounds will be checked and recorded. 

Abdominal images will be taken by radiograph (x-rays) and an ultrasound may be done to get a detailed look at what is going on in your dog’s stomach and intestinal tract. If necessary, your veterinarian may also perform an MRI or CT scans. Laboratory tests needed for diagnosis include urinalysis, arterial blood gas, complete blood count, and a blood chemical analysis. The serums your veterinarian will want to monitor are myoglobin, phosphokinase, creatinine, calcium, electrolytes, and hematocrit. Also, an electrocardiogram (EKG) may be used to check electrical and muscular defects of the heart.

Treating Indian apple poisoning is based on the test results and condition of your pet during the visit. The most common treatment given in this case is emesis, fluid therapy, medication, and possibly hospitalization for observation.

Emesis

To get the Indian apple residue out of your dog’s system, the veterinarian will give syrup of ipecac by mouth to induce emesis (vomiting). Magnesium citrate and activated charcoal will also be given by mouth to absorb the podophyllotoxin.

Fluid Therapy

A gastric lavage is sometimes done to rinse the remaining plant particles and resin from the stomach and intestinal tract. Intravenous (IV) fluids will then be given to flush the kidneys and to prevent dehydration.

Medication

Antacids and stomach protectants can be given for gastric distress. Topical cream or ointment is usually applied for dermatitis and inflammation.

Hospitalization

Your dog will only be hospitalized if the symptoms are severe or he is not responding to treatment. This is rare, but is sometimes found in cases of large ingestion and exposure.

If you obtained treatment for your dog within 24 hours, the side effects are easily remedied and reversed in almost all cases. However, in cases of high exposure, a hospital stay may be necessary. Continue to observe your pet for several days to watch for complications and call the veterinarian if there are any problems.