Intoxication from Ferula sumbul leaves in a mother and her infant.

Abstract

The genus Ferula comprises approximately 130 species that are distributed from the Mediterranean region to Central Asia. This genus is well documented as a source of biologically active compounds such as coumarins, terpene alcohols and sesquiterpene derivatives (1). Some of the isolated compounds of the dried roots of Ferula sumbul have anti-HIV activity and also demonstrate weak inhibition of cytokine release (1). Powder from F. sumbul roots are mixed with honey and used as aphrodisiac by men in some cultures (2). We report a case of a mother and her infant who over ingested F. sumbul leaves. To the best of our knowledge, this is the first report about intoxication with F. sumbul leaves in the literature. A 5-month-old female infant presented to our pediatric emergency department with the chief complaint of vomiting that started 2 hours after breastfeeding. Her mother also presented to the adult emergency department for vomiting. A thorough history revealed that F. sumbul leaves were harvested by mistake instead of green onion from the family garden. The mother, son and husband ate uncooked F. sumbul leaves. The Grandmother realized that the ingested plant was not green onion after the family had already consumed it. The mother began to vomit 2 hours after ingestion. Past medical histories of baby and mother were unremarkable. On physical examination of the baby, the vital findings were normal. Head circumference, body weight and height were within normal limits. No abnormal findings were noted on examination. Laboratory examination showed no abnormalities in complete blood count, serum electrolytes, coagulation parameters, renal and liver function tests. The infant was hospitalized and intravenous fluid was given for 2 hours. No medication was administered. Vomiting improved after a few hours without change in clinical status. Both the mother and infant were discharged home after 5 hours in emergency department. F. sumbul is a rich source of coumarin (1). Hepatotoxicity including elevated serum transaminases and hepatomegaly has been reported following coumarin treatment (4). In our case, there was no evidence of hepatotoxicity. Previous studies have also noted coumarins’MAO inhibiting effect (3). After oral administration coumarin is rapidly absorbed from the gastrointestinal tract and extensively metabolized by hepatic CYP2A6 to 7-hydroxycoumarin, which is excreted in the urine. The half-life for the elimination of coumarin is 1–2 hours in humans (4). We hypothesized that vomiting 2 hours after oral intake of F. sumbul is due to MAO-A inhibition causing high serotonin levels and stimulating 5HT3 receptors. MAO-A inhibition can also cause high norepinephrine and epinephrine levels, but we did not see significant adrenergic side effects in these patients (3). Other family members that ate F. sumbul leaves did not *Corresponding author: Dr. Hatice Derin, MD, Necmettin Erbakan University, Meram Medical Faculty, Department of Pediatrics, 42080 Meram, Konya, Turkey. Tel.: +90 332 223 75 46; Fax: +90 332 223 61 81 and +90 332 223 61 82. E-mail: haticederinkurt@gmail.com. Journal of Pediatric Intensive Care 2 (2013) 193–194 DOI 10.3233/PIC-13066 IOS Press 193