Carboxyatractyloside poisoning in humans.
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.
Turgut
Mehmet
M
Department of Pediatrics, Faculty of Medicine, Firat University, Elazig, Turkey. drmturgut@hotmail.com
Alhan
Cafer Cumhur
CC
Gürgöze
Metin
M
Kurt
Abdullah
A
Doğan
Yaşar
Y
Tekatli
Muhittin
M
Akpolat
Nusret
N
Aygün
A Denizmen
AD
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*
D001278:Atractyloside; C003853:carboxyatractyloside