Journal of Clinical Toxicology
Open Access

Abstract

Epidemic Self-Poisoning with Seeds of Cerbera manghas in Eastern Sri Lanka: An Analysis of Admissions and Outcome

Pirasath Selladurai, Sundaresan Thadsanamoorthy and Gnanathasan Ariaranee C

The use of plant fruits and seeds as a method of self-poisoning is common in South Asia, with most deaths being due to ingestion of (yellow oleander) seeds. Self-poisoning with the locally common Cerbera manghas (CM) fruit is prevalent in the Eastern Province of Sri Lanka. We carried out a retrospective study to determine the clinical manifestations, treatment and outcome of patients with cerbera manghas self-poisoning in Batticaloa teaching hospital. Data were collected retrospectively on all cases with Cerbera manghas self-poisoning from 1st January 2011 to 31st October 2013.There were 48 patients [mean age: 21(± 0.43) yrs], (male: female=35:13). Twenty four had ingested half of a seed (25 g). Most of the patients were symptomatic with vomiting (48), dizziness (24) and abdominal pain (20). Forty (83.3%) had cardiac arrhythmias that required transfer to the poisoning unit for specialized management. Severe cardiac toxicity was observed among patients (18) with fewer amount of seeds (25 g) compared to patients (8) with large amount of seeds (50 g). The 1st degree heart block (10, 20.8%), 2nd degree heart block (Type I:5, 10.4%, type II:12, 25.0%), complete heart block (10, 20.8%) and sinus bradycardia (5, 10.4%) were ECG findings. Fourteen (29.16%) had high serum potassium concentrations between 6.0 and 6.9 mmol/L; ten had life threatening hyperkalemia (>7.0 mmol/L). All patients were treated with multiple doses of activated charcoal. Temporary cardiac pacing was required in nine (18.7%) cases. There were eight deaths (16.7%), due to third-degree heart block and life threatening hyperkalemia. Cerbera manghas self-poisoning was common among young males in Batticaloa district of Sri Lanka’s Eastern Province. Cardiac toxicity was observed in patients with fewer amounts of seeds. Patients presenting with complete heart block and severe hyperkalemia had great risk of mortality.