A _2 years_ old child brought to ED with vomiting, 30 minutes after ingestion of unknown amount of the below plant.
1. What is the name of this plant?
2. What is the expected toxicity and how to manage?
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A _2 years_ old child brought to ED with vomiting, 30 minutes after ingestion of unknown amount of the below plant.
1. What is the name of this plant?
2. What is the expected toxicity and how to manage?
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Scary Botanical Cont'
Calotropis procera (Aiton)
Common names: apple of Sodom, rubber tree
The whole plant is toxic specially leaves and stem contain calotropin and calatropagenin.
o The latex contains glycosides, usacharin, clatoxin, calactin (a powerful bacteriolytic enzyme) and may contain
cardenolides.
o Besides the glycosides, this plant also contains oxalates, proteolytic enzymes and an unidentified allergen.
Clinical manifestation
*The sap (latex) is known to cause skin and GI irritation. Ingestion may cause intense irritation and burning
sensation of the mouth.
*Pharyngeal or laryngeal, edema may be present.
*Patient may develop vomiting,
depression, weakness, incoordination, seizures, respiratory paralysis, intestinal stasis and myocardial toxicity
due to cardenolides.
o Calotropis has vesicant latex that may cause severe reaction on skin, and mucous membranes. Eye exposure may result in severe keratoconjunctivitis.
o The cardioactive steroids toxicity depends on the amount ingested. Systemic manifestations including
dysrhythmias (sinus bradycardia, premature ventricular contractions, atrioventricular conduction defects, or
ventricular tachydysrhythmias) and hyperkalemia.
Treatment
o The treatment is basically supportive.
o Exposed eyes should be irrigated with copious amounts of tepid water for at least 15 minutes. If irritation, pain
swelling, lacrimation, or photophobia persists, the patient should be examined by an ophthalmologist.
o Skin is decontaminated with thorough washing; calamine lotion may be applied locally.
o Calcium oxalate cause local pain and edema
o Cool water and analgesics can be of help to reduce the irritation symptoms.
o For the cardioactive steroid toxicity, GI decontamination as well as serial electrocardiography, serum potassium
should be performed.
*Consider using digoxin-specific Fab for serious toxicity
References:
National Management Guidelines of poisoning 3rd edition
It was observed from the study that most of the patients had abdominal pain as the major symptom. Stomatitis was the second most common symptom. It was observed consumption of the toxin in lesser quantities produced these symptoms, in large quantities produced tachycardia, hyperkalemia and convulsions.
Treatment is supportive. Calotropis still continues to be used in various herbal remedies and has several medico legal implications. Judicial use, optimization of reporting and facilitating further research is warranted.
Calotropin, like calactin, calotoxin, and uscharin are derived from calotropogenin. These chemicals are called Cardenolides. Cardenolides are glycosides; cardiac active steroids which contain a 5 member lactone ring.
Cardenolides like Calotropin act on the Na+/K+ ATPase pump, this enzyme is responsible for the active transport of sodium and potassium across the membrane. The inhibition of this pump affects the resting membrane potential and is the suggested mechanism for toxicity of Cardenolides cardiac toxicity.
The toxicity of Cardenolides is due to their ability in inhibiting the Na+ K+ ATPase pump. Our current understanding is that the Calotropin biosynthesis is similar to that of Digoxin. Other commonly used plant toxin for deliberate self-harm Oleander also contains Cardenolides.
Calotropis is a widely prevalent plant in the Indian Subcontinent. The extract and various parts of the plant are used by traditional healers for treating miscellaneous diseases. All parts of the plants are toxic; there are many case reports of gastrointestinal, cutaneous and ocular toxicity with Calotropis. The plant contains Cardenolide glycosides which have Digoxin like effects and can cause severe cardiotoxicity.
Thanks for the quiz. Grateful for this opportunity.
The name of this plant is Calotropis Procera. Its toxic as a whole in particular its leaves and stem
It contain calatropin and calatropagenin along with oxalates, proteolytic enzymes and allergens.