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Carboxyatractyloside poisoning
in humans.
Turgut
M, Alhan
CC, Gurgoze
M, Kurt
A, Dogan
Y, Tekatli
M, Akpolat
N, Aygun
AD.
Department of Pediatrics, Faculty of Medicine, Firat
University, Elazig, Turkey. drmturgut@hotmail.com
OBJECTIVE:
Cocklebur (Xanthium strumarium) is an herbaceous annual plant with
worldwide distribution. The seeds contain the glycoside
carboxyatractyloside, which is highly toxic to animals. We describe nine
cases of carboxyatractyloside poisoning in humans which, to our
knowledge, has not previously been reported. The clinical, laboratory
and histopathological findings and our therapeutic approach are also
discussed. SUBJECTS AND METHODS: The patients presented with acute onset
abdominal pain, nausea and vomiting, drowsiness, palpitations, sweating
and dyspnoea. Three of them developed convulsions followed by loss of
consciousness and death. RESULTS: Laboratory findings showed raised
liver enzymes, indicating severe hepatocellular damage. BUN and
creatinine levels were raised, especially in the fatal cases who also
displayed findings of consumption coagulopathy. CPK-MB values indicative
of myocardial injury were also raised, especially in the fatal cases.
Three of the patients died within 48 hours of ingesting
carboxyatractyloside. Post-mortem histopathology of the liver confirmed
centrilobular hepatic necrosis and renal proximal tubular necrosis,
secondary changes owing to increased permeability and microvascular
haemorrhage in the cerebrum and cerebellum, and leucocytic infiltrates
in the muscles and various organs including pancreas, lungs and
myocardium. CONCLUSIONS: Carboxyatractyloside poisoning causes multiple
organ dysfunction and can be fatal. Coagulation abnormalities,
hyponatraemia, marked hypoglycaemia, icterus and hepatic and renal
failure are signs of a poor prognosis. No antidote is available and
supportive therapy is the mainstay of treatment.
PMID: 15949201
[PubMed - in process]
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