An unusual case of cardiac glycoside toxicity

Kassop, David; Donovan, Michael; Cohee, Brian M.; Mabe, Donovan; Wedam, Erich F.; Atwood, J. Edwin

doi:10.1016/j.ijcard.2013.11.019

Cited by 13 publications

(14 citation statements)

References 7 publications

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“…Deaths, both homicides and suicides, are almost certainly underreported, as the only method of identifying C. odollam toxin is by thin-layer chromatography. 7 For this reason we were unable to obtain a glycoside blood level; however, we believe that the patient’s history (admitted suicide attempt using “pong-pong” seeds) and hospital course (bradycardia, ECG changes, hyperkalemia) are sufficient to give a diagnosis of C. odollam poisoning.…”

Section: Discussionmentioning

confidence: 99%

Fatality Following Intentional Ingestion of Cerbera odollam Seeds

Misek

Allen

LeComte

et al. 2018

CPC-EM

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Seeds from the mangrove plant Cerbera (C.) odollam, known as the “suicide tree,” are responsible for a significant number of plant deaths worldwide but are not well recognized in Western medicine. Cerberin is a cardiac glycoside concentrated in the plant’s seeds, which causes disrupted cardiac electrical activity leading to fatal dysrhythmias. We present a fatal case of intentional C. odollam seed ingestion. The patient experienced high-degree heart block and cardiac arrest despite supportive treatment and digoxin immune fab administration. Clinicians should be aware of the potential morbidity and mortality associated with C. odollam poisoning and be prepared for resuscitative interventions.

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Section: Discussionmentioning

confidence: 99%

Fatality Following Intentional Ingestion of Cerbera odollam Seeds

Misek

Allen

LeComte

et al. 2018

CPC-EM

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“…Cardiac glycosides (cardenolides) such as cerberin reversibly inhibit the sodium-potassium adenosine triphosphatase (Na + -K + -ATPase) exchanger in myocardial cells. [ 2 9 ] This leads to increased levels of calcium in cardiac myocytes which causes increase in automaticity, increased vagal tone, and hyperkalemia. [ 10 ] All these produce cardiac arrhythmias and heart blocks.…”

Section: Discussionmentioning

confidence: 99%

“…Timely use of pacemaker therapy has brought down the mortality of patients. [ 5 ] Although there are reports of use of digoxin-specific antibody fragments in managing the patients with odollam poisoning,[ 2 12 ] none of the patients in the study population received that. We observed a mortality rate of 16.7%, which was comparable to other similar studies.…”

Section: Discussionmentioning

confidence: 99%

“…[ 3 16 ] This plant is largely unknown to the western world, but there are reports of its use in the western countries after ingestion of seeds purchased online. [ 2 12 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 ] Deliberate self-harm with fruit of this plant is a major clinical problem in the developing world; however, it is relatively unknown to the western physicians. [ 2 ] Ease of availability makes C. odollam kernels, the cause of deaths in more than half of Kerala's ingested plant poisonings. [ 3 ] The fruits of this tree are smooth and round and contain a single large seed.…”

Section: Introductionmentioning

confidence: 99%

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Study on clinical profile and predictors of mortality in Cerbera odollam poisoning

Renymol

Palappallil

Ambili

2018

Indian Journal of Critical Care Medicine

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Context:Cerbera odollam is a tree native to South Asia. It belongs to the poisonous Apocynaceae family. Deliberate self-harm with fruit of this plant is a major clinical problem in the developing world. Ingestion of C. odollam kernels is the cause of deaths in more than half of Kerala's plant poisoning deaths. The data on clinical features and complications of C. odollam poisoning are sparse, apart from a few case reports and limited studies.Aims:The present study was done to find the mode of presentation, complications, need for cardiac pacing, inhospital mortality, and the predictors of mortality in patients with C. odollam poisoning.Settings and Design:This was a retrospective study conducted in the department of general medicine in a tertiary care center in Alappuzha district, Kerala. The study period was for 1 year from January 1, 2016, to December 31, 2016.Subjects and Methods:All the patients admitted with a history of ingestion of odollam during the study period were included in the study. Data were collected from case records. The study was approved by the institutional ethics committee and research committee (IEC/TDMCA/EC3.dated29/11/201).Statistical Analysis Used:The data were analyzed using SPSS 16 for Windows (SPSS Inc., Chicago, IL, USA).Results:In this study, 102 patients were identified with C. odollam poisoning, and the mortality rate was 16.7%. Electrocardiogram (ECG) changes were common in our patients, and we observed different types of heart block in the same ECG itself. Ingestion of more than two kernels of odollam, late presentation to hospital, vomiting, bradycardia, hypotension, hyperkalemia, and more severe ECG changes were associated with significantly higher mortality in this study.Conclusions:C. odollam poisoning is a common method of deliberate self-harm in Kerala. It carries a high mortality rate, and the predictors of mortality include vomiting, bradycardia, hypotension, hyperkalemia, and the presence of severe ECG changes.

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