Detection of poisoning by Impila (Callilepis laureola) in a mother and child

Abstract

<jats:p> Poisoning with impila (Callilepis laureola) is a recurring phenomenon in South Africa. Cases of poisoning with other plants which contain atractyloside also occur in Europe and the Americas. Since poisoning leads to rapid death from renal and/or hepatic failure, it is suspected that many cases are undiagnosed; this is especially so in South Africa, where patients may die without reaching hospital and do not often admit to ingestion of a traditional remedy. </jats:p><jats:p> We have developed a thin layer chromatographic method for the detection of impila constituents in urine. We describe the clinical symptoms and the application of the screening method to diagnosis in the case of a mother and child, who both showed symptoms of impila poisoning; the mother died but the child survived. This method is rapid and may be used for the definitive diagnosis in cases of poisoning with atractyloside-containing plants. </jats:p>

Hepatotoxic Botanicals - An Evidence-based Systematic Review

“…However, Impila is a sever poison and patients poisoned by it show sever hypoglycemia (102). Moreover, several reports reported cases of hepatotoxicity and renal toxicity including acute renal failure (241), hepatocellular necrosis (98) and hepatic and renal dysfunction along with hypoglycemia (102) as well as death (99). As in Atractylis gummifera, Callilepsis laureola contains toxic atractylosides, which is responsible for fulminant hepatitis and renal tubular necrosis injury (101).…”

“…Callilepsis laureola or Impila is another dangerous herb (97). It is a multifunctional remedy that used for treating stomach discomfort, cough, worm infection and impotence (97,98). However, Impila is a sever poison and patients poisoned by it show sever hypoglycemia (102).…”

“…Another case involved a mother (21-year-old) and her daughter (1-year-10-month-old) who consumed Impila and developed a toxic reaction. The mother died due to hepatocellular necrosis whereas the child recovered (98).…”

“…Impila has been traditionally used as a remedy for stomach problems, infertility, cough and worm infection (96). Additionally, C. laureola was used to word off the evil spirits (98). It is known to be highly toxic and very poisonous plant that is responsible for several deaths (99).…”

Identification of atractyloside by LC–ESI–MS in alleged herbal poisonings

“…However, C. laureola, which contains atractyloside (ATR) and carboxyatractyloside (CATR; Fig. 1) [14][15][16] as toxic principles, has also been implicated in the death of numerous patients who used medication prepared from impila [2,4,6,7,9,12,17,18]. Atractyloside has a strychnine-like action and gives rise to hypoglycaemic type convulsions [19], which may be accompanied with gastrointestinal symptoms, confusion, stupor and coma [20].…”