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

Abstract

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.

A Case of Attempted Suicide by Cerbera odollam Seed Ingestion

“…The body mass index of the consumer possibly determines the fatal amount [6]. In 102 patients studied by Renymol et al, consumption of more than two kernels was positively associated with mortality (OR of 5.12, CI of 1.54-17.04, and P = 0:004) [11]. Our patient with a BMI of 21.71 kg/m 2 reported consuming one seed and survived.…”

“…According to a 2016 study of 50 odollam poisoning cases in India, the most frequent symptom is vomiting (54% of the studied patients); thrombocytopenia was observed in 50% of patients; the most common ECG abnormality was sinus bradycardia (32%), followed by sinus pause (28%) [10]. However, another study out of India of 102 patients reported varying degrees of heart block (58%) as the most common ECG finding [11]. Junctional rhythm seen in our patient is infrequently reported [9].…”

“…Early animal studies found ingestion of a small amount of the seed to be fatal, with the lethal dose of cerberin at 1.8 mg/kg for a dog, 3.1 mg/kg for a cat, and 50 mg/kg for a rabbit [2]. Some studies report a minimum lethal dose for humans of half an odollam kernel, while others report that one full kernel is required for full lethal effect [11]. The body mass index of the consumer possibly determines the fatal amount [6].…”

“…While cerberin toxicity is rare in the United States, it is well known in the Asia-Pacific region. In the southwestern Indian state of Kerala, a single medical center alone reported 102 cases of odollam poisoning during the 2016 year [11]. Another study in Kerala showed that from 1989 to 1999, there were 537 reported deaths due to odollam poisoning [1].…”