Fatal plant poisoning in Kasturba hospital,

Manipal

Pinakini KS, Mohan Kumar TS, Vikram Palimar, Pradeep Kumar G

Dept of Pharmacology, MMMC, Manipal Dept of Forensic Medicine,

KMC,Manipal

Introduction

Plant poisoning may be accidental,

self induced, or homicidal

Diagnosis is difficult / impossible

Clinical features mimic natural

disease

Lack of knowledge of plants

Different nomenclatures

Materials and Methods

A 12 year retrospective study

(1993-2004)

Hospital records

Autopsy reports

FSL reports

Profile of poisoning deathsType No. of cases %

Organophosphorus

244 65.5

Organochlorines 26 7.1

Carbamate 17 4.6

Zinc phosphide 12 3.2

Copper sulphate 12 3.2

Medicinal drugs 9 2.4

Alcohol 6 1.6

Plants 6 1.6

Corrosives 7 1.9

Mixed 8 2.1

Others 11 2.93.8Unknown 14

Total 372 100

Clinical profile Age/sex Plant Pulse/

min BP

1. 37yr-M Cerbera thevetia2 seeds

70 120/70

2. 22yr-F

3. 55yr-M

4. 30yr-F

Cerbera thevetia2 seeds

Cerbera odollumCerbera odollum

fruit

60

82

32

94/60

180/100

80/60

Clinical profile

Period of survival

ECG

1. 37yr-M

18 hrs Sinus Nodal Dysfunction

2.22yr-F

3. 55yr-M

4. 30yr-F

10 hrs

60 hrs

10 hrs

AV dissociation

Normal

AV dissociation

Lab parameters

Case K+

mEq/

Urea

mg/dl

Creatinine

mg/dl

Bilirubin mg/dl

AST

U/l

ALT

U/l

1 8.8 24 2.2 1.3 53 32

2 4 30 0.9 1.1 46 28

3 4.2 47 0.8 0.8 46 21

4 4.5 28 1.1 0.7 40 36

* Sahu et al, ‘Yellow oleander poisoning with jaudice & renal failure’. JAPI 1989

Treatment

Gastric lavage

Inj atropine: bradyarrythmias

Temporary pacemaker: femoral vein

Phenytoin / lignocaine:

tachyarrythmias

Autopsy findings

Congestion of GI tract

Brain congested & edematous

Heart - Subendocardial haemorhages

Kidneys bilaterally congested

FSL-Cardiac glycosides in the viscera

Discussion Cardiac glycosides: Cerbera thevetia &

odollum

Apocynaceae

Active principles:

cerberin, odolin, thevetin & thevotoxin

Accidental in children

Suicidal/homicidal: adults

Cardiac manifestations

Questions

Comments

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