title: Herbal tea induced hepatic veno-occlusive disease: quantification of toxic alkaloid exposure in adults.
abstract: Four young Chinese women took daily doses of an unidentified 'Indian' herbal tea as treatment for psoriasis. Three (one of whom died), developed ascites, hepatomegaly and biochemical abnormalities within 19-45 days. The fourth patient discontinued herbal tea after 21 days when she developed a skin rash. Two patients had portal hypertension, while all had liver histology showing features of veno-occlusive disease. Pyrrolizidine alkaloids were identified spectrophotometrically in the brewed tea, and in the chopped leaves of the herbal mixture; the mean dose in the tea prepared for consumption being 12 mg/day of alkaloid base and 18 mg/day of N-oxide. The mean cumulative dose of alkaloids (base + N-oxide) before onset of symptoms (three patients), was estimated to be 18 mg/kg. In the asymptomatic patient with histological liver disease only, the corresponding dose was 15 mg/kg. These cases thus provide some measure of pyrrolizidine alkaloid toxicity in adults.
mesh_terms: D000328:Adult; D001628:Beverages / Q000032:analysis / Q000506:poisoning*; D003251:Constriction, Pathologic / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008517:Phytotherapy; D010939:Plant Poisoning / Q000209:etiology* / Q000473:pathology; D011565:Psoriasis / Q000628:therapy; D011763:Pyrrolizidine Alkaloids / Q000032:analysis / Q000506:poisoning*; D014652:Vascular Diseases / Q000209:etiology* / Q000473:pathology; D014680:Veins / Q000473:pathology
chemical_list: D011763:Pyrrolizidine Alkaloids