Cycas revoluta (sago cycad) exposures reported to Texas poison centers

Background: Cycas revoluta (sago cycad or palm) is a popular ornamental plant in the United States. All parts of the plant contain toxins such cycasin and beta-methylamino-l-alanine, the ingestion of which can be harmful to humans and animals. The objective of this study was to characterize C. revoluta exposures reported to poison centers. Methods: Cases were C. revoluta exposures reported to Texas poison centers during 2000–2018. The distribution of cases by selected variables was determined. Results: Of 192 total C. revoluta exposures, the most common exposure routes were ingestion (55.7%) and dermal (34.4%). The patient age distribution was 28.1% 5 years or less, 15.1% 6–12 years, 4.7% 13–19 years, and 50.5% 20 years or more; 55.2% were male. The exposure was unintentional in 92.2% of the cases and occurred at the patient's own residence in 94.8%. The patient was managed on site in 78.6% of the cases, already at/en route to a healthcare facility in 12.0%, and referred to a healthcare facility in 8.9%. The most common reported clinical effects were dermal (23.4%), particularly puncture/wound (16.1%), dermal irritation/pain (14.6%), and edema (8.9%), followed by gastrointestinal (13.0%), particularly vomiting (8.9%) and nausea (7.8%). Conclusion: Most of the C. revoluta exposures tended to be unintentional and occurred at home. Although most of the C. revoluta exposures involved ingestion, 35% were dermal, and the most frequently reported clinical effects were dermal followed by gastrointestinal. Most of the exposures were not serious and were managed outside of a healthcare facility.