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.