Abstract
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.
Highlights
While self-poisoning with Pesticides is the most common method of self-harm in Asia, self-poisoning with plant seeds or fruits is common, especially in the South Asian region [1]
We noted that cases of self-poisoning with Cerbera manghas fruits, while being most commonly reported in Tamil Nadu and Kerala [3,4] are seen in the Eastern Province of Sri Lanka
Treatment of patients Patients with Cerbera manghas poisoning were treated in medical wards and poisoning unit, tertiary care hospital in Eastern Sri Lanka with different treatment modalities such as activated charcoal, intravenous boluses of atropine/isoprenaline, temporary pacing and supportive measures depending on the clinical manifestations
Summary
While self-poisoning with Pesticides is the most common method of self-harm in Asia, self-poisoning with plant seeds or fruits is common, especially in the South Asian region [1]. We noted that cases of self-poisoning with Cerbera manghas (sea mango, pink eyed cerbera, odollam tree) fruits, while being most commonly reported in Tamil Nadu and Kerala [3,4] are seen in the Eastern Province of Sri Lanka. In Sri Lanka, especially along coastal regions, sea mango (Cerbera manghas) is a very common plant and readily accessible. It grows to a height of 5 to 10 metres and bears whorled branchlets with terminal lanceolate leaves. The latex present throughout the plant contains cardenolides
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