Acute Liver Failure with Renal Impairment Related to the Abuse of Senna Anthraquinone Glycosides

Abstract

Ingestion of large doses of senna laxatives may expose people to the risk of hepatotoxicity.

Medicinal Potentials and Toxicity Concerns of Bioactive Principles

“…Persistent use or abuse of anthraquinone glycosides medications, beside its strong anti-bacterial, antioxidant and anti-diabetic activities, could elicit fluid and electrolyte loss, rhabdomyolysis, renal failure and acute hepatic failure [175][176][177]. Cardiac glycosides derivatives of digitalis and strophanthus such as ouabain are notable inhibitor of Na + /K + -ATPase activity of biomembranes [173,178].…”

Hepatotoxic Botanicals - An Evidence-based Systematic Review

“…angustifolia, commonly known as Senna or Tinnevelly, is a plant that is native to Arabia and belongs to Fabaceae family (141,142). The leaves (pods) and fruits of senna have been used as laxative in form of herbal tea (141,142).…”

“…Another case of senna hepatotoxicity involved a 52-year-old woman who drank 1L of herbal tea containing 70 g of Senna dried fruit for more than 3 years. The patient developed acute liver failure with renal impairment due to chronic use of C. angustifolia (141). Moreover, a 42-year-old female presented with epigastric pain, vomiting and intermittent fever after intake of 200 ml of dried senna leaves for 2 years.…”

“…The patient admitted taking Senna for the treatment of constipation (144). Additionally, chronic use of C. angustifolia has been associated with serious conditions like chronic diarrhea and loss of fluid and electrolyte (141). Furthermore, cases of sever hepatic damage associated with Senna are rare.…”

Household Expenditures on Dietary Supplements Sold for Weight Loss, Muscle Building, and Sexual Function: Disproportionate Burden by Gender and Income

“…In fact, the U.S. Food and Drug Administration has been well aware of this heightened risk for many years, and in 2010 issued a special warning to consumers regarding supplements sold for weight loss, muscle building, and sexual function as being more likely than other supplements to be deceptively marketed and tainted with toxic ingredients (U.S. Food and Drug Administration, 2010). Effects with adverse health consequences can include for weight-loss supplements: chronic diarrhea and constipation, dehydration, hypokalemia, metabolic acidosis, and other electrolyte imbalances, cardiac arrhythmia, hemorrhagic and ischemic stroke, hepatic and renal failure; (Steffen et al, 2007;Roerig et al, 2003;Schneider, 2003;Copeland, 1994;Tozzi et al, 2006;Vanderperren et al, 2005;Crow, 2005) for muscle-building supplements: infertility, testicular cancer, stunted growth, coronary artery disease, pulmonary embolism; (Liyanage and Kodali, 2014;Li et al, 2015) and for sexual-function supplements: changes in blood pressure, hypomania, insomnia, anxiety, irritability, nausea, headaches, loss of consciousness, seizures (Cohen and Venhuis, 2013;Corazza et al, 2014).…”