title: Carboxyatractyloside poisoning in humans.
abstract: OBJECTIVE
  Cocklebur (Xanthium strumarium) is an herbaceous annual plant with worldwide distribution. The seeds contain the glycoside carboxyatractyloside, which is highly toxic to animals. We describe nine cases of carboxyatractyloside poisoning in humans which, to our knowledge, has not previously been reported. The clinical, laboratory and histopathological findings and our therapeutic approach are also discussed.
  
  
  METHODS
  The patients presented with acute onset abdominal pain, nausea and vomiting, drowsiness, palpitations, sweating and dyspnoea. Three of them developed convulsions followed by loss of consciousness and death.
  
  
  RESULTS
  Laboratory findings showed raised liver enzymes, indicating severe hepatocellular damage. BUN and creatinine levels were raised, especially in the fatal cases who also displayed findings of consumption coagulopathy. CPK-MB values indicative of myocardial injury were also raised, especially in the fatal cases. Three of the patients died within 48 hours of ingesting carboxyatractyloside. Post-mortem histopathology of the liver confirmed centrilobular hepatic necrosis and renal proximal tubular necrosis, secondary changes owing to increased permeability and microvascular haemorrhage in the cerebrum and cerebellum, and leucocytic infiltrates in the muscles and various organs including pancreas, lungs and myocardium.
  
  
  CONCLUSIONS
  Carboxyatractyloside poisoning causes multiple organ dysfunction and can be fatal. Coagulation abnormalities, hyponatraemia, marked hypoglycaemia, icterus and hepatic and renal failure are signs of a poor prognosis. No antidote is available and supportive therapy is the mainstay of treatment.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Firat University, Elazig, Turkey. drmturgut@hotmail.com
authors.forename: Mehmet
authors.initials: M
authors.lastname: Turgut
authors.forename: Cafer Cumhur
authors.initials: CC
authors.lastname: Alhan
authors.forename: Metin
authors.initials: M
authors.lastname: Gürgöze
authors.forename: Abdullah
authors.initials: A
authors.lastname: Kurt
authors.forename: Yaşar
authors.initials: Y
authors.lastname: Doğan
authors.forename: Muhittin
authors.initials: M
authors.lastname: Tekatli
authors.forename: Nusret
authors.initials: N
authors.lastname: Akpolat
authors.forename: A Denizmen
authors.initials: AD
authors.lastname: Aygün
mesh_terms: D000293:Adolescent; D000328:Adult; D001278:Atractyloside / Q000031:analogs & derivatives* / Q000506:poisoning; D009202:Cardiomyopathies / Q000209:etiology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000209:etiology; D004211:Disseminated Intravascular Coagulation / Q000209:etiology / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006368:Helianthus; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology / Q000473:pathology; D008107:Liver Diseases / Q000209:etiology / Q000473:pathology; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology* / Q000473:pathology; D010939:Plant Poisoning / Q000175:diagnosis* / Q000473:pathology; D012640:Seizures / Q000209:etiology / Q000473:pathology; D014839:Vomiting / Q000209:etiology; D031210:Xanthium / Q000506:poisoning*
chemical_list: D001278:Atractyloside; C003853:carboxyatractyloside