Utilizing Toxidromal Approach in Managing Series of Botanically Related Medicolegal Emergencies

Abstract

As with many other medicolegal dilemma in poisoning, in which whom to blame for the toxic exposure, and who should be punished. Since after the decriminalization of suicidal attempt under section 309 IPC, victim himself can’t be held responsible for the harm caused to him/her by self. But abatement of suicide is still a crime, so if someone harasses another person physically or mentally or psychologically, and the victim consumes some toxic plant product under stress, than it becomes a medicolegal case to be reported to police, to protect the victim and restrain the accused for causing further harm. Bedside care of patients with toxic plant exposures should be managed primarily based on their clinical manifestations and responses to therapy and only secondarily on the basis of the toxin to which they are presumably exposed. The dictum has been and remains “Treat the patient, not the poison”. But don’t ignore the poison. We report few interesting cases reported in our ER: self-intoxication during voluntary ingestion of nutmeg-myristicinas aphrodisiac, self-overdose of Calotropis seeds as purgative by young female, Homicidal Atropa seeds toxicity in a child, Areca Nut aspiration by male Gutkha chewer, Opium intoxication in youth, Oriental Starfruit causing nephrotoxicity, Bottle gourd juice causing UGI Bleed, Cannabis abuse simulating Acute coronary syndrome. Toxidromal Approach simplified theapproach to differential diagnosis and emergency management of symptomatology and aetiology of intoxication, thus saving lives and improving quality of acute care.