Fatal 3-Nitropropionic Acid Poisoning after Consuming Coconut Water.

Stig Eric Dyrskog,Travis M. Falconer,Jakob A. Østergaard,Dorte G. Illum,Søren Overballe-Petersen,Jørgen S. Jensen,Rakel F. Johansen,Chris Andersen,Thomas Birkelund,Helena Fridholm

doi:10.3201/eid2701.202222

Abstract

We describe the fatal course of a patient with initial symptoms of vomiting and nausea who developed symptoms of dystonia, encephalopathy, and coma. The cause of death was poisoning with 3-nitropropionic acid from coconut water spoiled with the fungus Arthrinium saccharicola. We present the clinical findings and forensic analysis.

Highlights

We describe the fatal course of a patient with initial symptoms of vomiting and nausea who developed symptoms of dystonia, encephalopathy, and coma
The type of ecologically grown coconut involved in the case of a 69-year old Caucasian man in Aarhus, Denmark, who died of poisoning with 3-nitropropionic acid from coconut water spoiled with the fungus Arthrinium saccharicola
Fungi of the Arthrinium genus produce the lipophilic and highly toxic 3-nitropropionic acid (3-NPA), which is involved in the etiology of moldy sugar cane poisoning [8] with severe encephalopathy [9]. 3-NPA irreversibly binds to and inhibits succinate dehydrogenase in the mitochondria, thereby blocking the citric acid cycle and ATP generation in cells, which would explain the observed severe lactate acidosis

Summary

Introduction

We describe the fatal course of a patient with initial symptoms of vomiting and nausea who developed symptoms of dystonia, encephalopathy, and coma. 4.5 hours before admission, the patient had consumed coconut water directly from a coconut using a straw. 3 hours after drinking the coconut water, the patient developed sweating, nausea, and vomiting.

Results

Conclusion