Ingestion of false hellebore plants can cross-react with a digoxin clinical chemistry assay

Introduction. We report a case of digoxin-like toxicity because of ingestion of foraged plants. This patient presented with nausea, vomiting, bradycardia, and hypotension after ingesting Veratrum viride (false hellebore). The patient's serum specimen demonstrated a positive digoxin level (0.38 ng/mL) measured by a clinical tubidimetric immunoassay. We hypothesize that steroidal alkaloid compounds contained in V. viride cross-react with the Multigent T Digoxin immunoassay reagent antibodies. Results. Plant extracts from V. viride demonstrated cross-reactivity to Multigent T reagent antibodies but did not bind therapeutic DigiFab T antibodies. Gas chromatography/mass spectrometry analyses identified several steroidal alkaloid compounds present in the V. viride extracts: jervine, ribigirvine, solanidine, and veratraman. Conclusions. This study indicates that compounds extracted from V. viride can cross-react with a clinical Digoxin immunoassay. Yet these extracts did not bind DigiFab T antibody fragments used for therapeutic intervention. Providers should not unnecessarily administer DigiFab T fragments as an antidote in symptomatic V. viride toxic patients.