Bottle gourd (Lagenaria siceraria) juice poisoning

Abstract

BACKGROUND: Bottle gourd (Lagenaria siceraria) is popularly known as lauki, ghia or dudhi in India. Its consumption is advocated by traditional medicine healers for controlling diabetes mellitus, hypertension, liver diseases, weight loss and other diseases. However, in last few years there have been reports of suspected toxicity due to consumption of its juice leading to severe vomiting and upper gastrointestinal bleeding. As emergency physicians we need to be aware of this very rare poisoning specially in India. METHODS:We present a case of a 52-year-old woman who presented with multiple episodes of hematemesis and shock to the emergency department (ED) after consuming bottle gourd juice. The patient was resuscitated and stabilized with fl uids, proton pump inhibitors and antiemetics and shifted to the intensive care unit (ICU) under the care of a gastroenterology team for urgent endoscopy and further management. RESULTS:The patient received intravenous fluids, antibiotics, antiemetics, and antacids and underwent upper gastroenterologic endoscopy during the hospitalization. She was discharged in a stable condition 4 days later. CONCLUSIONS:As a member of the Cucurbitaceae family, bottle gourd contains toxic tetracyclic triterpenoid compounds called cucurbitacins which are responsible for the bitter taste and toxicity. There is no known antidote for this toxicity, and clinicians treat such patients symptomatically only. It is important to educate the public about the harmful effects of this potentially life-threatening toxicity.

Spray Drying of Bottle Gourd Juice: Effect of Different Carrier Agents on Physical, Antioxidant Capacity, Reconstitution, and Morphological Properties

“…Bottle gourd is a known to have different biologically active phytochemicals. The pharmacological effects 6 of the bioactive compounds present in bottle gourd have been assessed for numerous benefits such as hepatoprotective, 7 antioxidant, 8 cardioprotective, 9 anticarcinogenic, 10 and many more effects. It has been used more widely in juices 1 and sweetmeats, 2 which are widely acceptable in Indian subcontinents.…”

More Than Just A Gastroenteritis - Bottle gourd (Lagenaria Siceraria) Toxicity Diagnosed in the Emergency Department

“…Bottle gourd (Lagenaria siceraria) is believed to have many health bene ts and with the increased practice of traditional medicine, it is used as alternate therapies to treat ailments [1]. However, a handful of reports have been published regarding toxicity due to consumption of this juice [2] [3]. We report a case of bottle gourd juice toxicity diagnosed in the Emergency Department, review the literature in general, discuss the mechanism of toxicity and other substances that may present similarly.…”

“…However, toxic level of Cucurbitacin can accumulate in bottle gourd or when it is inappropriate processed. Consumption of such juice can result in serious toxic reactions which may potentially be fatal [2] [3]. Cucurbitacin is a tetracyclic triterpenoid which has been shown to have cytotoxic effects in animals and humans.…”

“…Nevertheless, there have been a few reports of toxicity due to consumption of bitter bottle gourd juice leading to severe gastrointestinal complications. Most patients present with abdominal pain, vomiting, diarrhoea, upper gastrointestinal bleeding and hypotension within 30 minutes to one hour after ingesting bitter bottle gourd juice and the symptoms may last up to 2 to 7 days [2] [3]. In recent years, researchers in India reported a few cases of patients experienced severe haematemesis and hypotension requiring inotropic support from this toxicity [2][3][10] [11].…”

“…There is no well described antidote for this toxicity and management is mainly supportive such as replacement of uid de cits, correction of electrolyte abnormalities, symptomatic treatment of vomiting, control of upper gastrointestinal bleeding, management of shock and blood transfusions if necessary [3].…”