<p>Clinical Characteristics of <em>Acalypha indica</em> Poisoning</p>

Abstract

Background: Acalypha indica is a tropical plant used as a herbal medicine in various parts of the world, including Thailand. In glucose-6-phosphate dehydrogenase (G6PD)-deficient patients, acute hemolysis has been reported following the ingestion of this plant. Methemoglobinemia was reported in the present study. Patients and Methods: Descriptive data of patients who suffered from Acalypha indica toxicity reported from different hospitals to the Ramathibodi Poison Center were retrieved from 2011 to 2019. Results: Eight patients were included, mostly male with a median age of 61.5 years. The plant was ground for fresh juice or boiled before consuming as herbal medicine. All patients presented with dark urine. Most had jaundice and fever, and all reported hemolysis. Seven out of eight patients were diagnosed as methemoglobinemia. Methemoglobin level was confirmed in five patients with the highest level of 23.9%. Early symptoms occurred within 24 hours of the last ingested dose. Discussion: In previous case reports of Acalypha indica ingestion, acute hemolysis was mostly observed in G6PD-deficient patients, consistent with the current findings. However, our patients also demonstrated methemoglobinemia, with some constituents in this plant (quinine, 2-methyl anthraquinone and tectoquinone) implicated as the cause in previous studies. Further studies are crucial to validate these findings. Conclusion: We report a case series in which acute hemolysis and methemoglobinemia after Acalypha indica ingestion were observed. This study presents methemoglobinemia as the other toxicity caused by this plant.

Acalypha indica induced acute oxidative haemolysis and methaemoglobinaemia: two case reports

“…Acute hemolysis with A. indica resulting in the subsequent discovery of G6PD deficiency was reported previously from South India, Sri Lanka, Malaysia, and Thailand, with most cases from Sri Lanka [ 2 , 3 , 7 – 12 ]. The majority of the reported patients were men.…”

“…A case series reported that symptoms of dark urine and jaundice develop as early as 15 min to 4 hour following consumption, however, the patients presented to the hospital after a delay of 2–4 days, with worsening haemolysis and acute kidney injury [ 2 ]. The only reported case of fatality due to A. indica -related haemolysis is of a 70-year-old male with premorbid chronic coronary artery and pulmonary disease [ 2 ]. Male sex, young age of presentation, no family history, fever, vomiting, and high alkaline phosphatase levels predict severe haemolysis [ 13 ].…”

“…Although the specific compound responsible for methaemoglobin formation was not identified in this case, it is important to consider the potential for such herbal remedies to induce methaemoglobinaemia. The occurrence of coexistent methaemoglobinaemia and haemolysis with A.indica is uncommonly reported [ 2 , 10 – 12 ]. Almost all reported cases of A.indica -induced methaemoglobinaemia were mild with a maximum level reported of 23.9% [ 2 ].…”

“…The occurrence of coexistent methaemoglobinaemia and haemolysis with A.indica is uncommonly reported [ 2 , 10 – 12 ]. Almost all reported cases of A.indica -induced methaemoglobinaemia were mild with a maximum level reported of 23.9% [ 2 ]. Cases of methaemoglobinaemia can go undetected, unless suspected.…”

“…Some ethnicities consume the leaves of A. indica as a cooked or raw vegetable. Three constituents, namely quinine, 2-methyl anthraquinone, and tectoquinone have oxidative properties, and thus can cause acute intravascular oxidative haemolysis and methaemoglobinaemia in susceptible individuals [ 2 ]. A. indica also contains acalyphin, a cyanogenic glycoside, and hydrogen cyanide, but reports of cyanide toxicity are uncommon.…”