title: Bitter bottle gourd (Lagenaria siceraria) toxicity.
abstract: BACKGROUND
  Bottle gourd (Lagenaria siceraria) is an edible plant in the Cucurbitaceae family. When extremely bitter, ingestion of bottle gourd can cause rapid onset diarrhea, vomiting, gastrointestinal bleeding, and hypotension due to release of a substance named cucurbitacin.
  
  
  OBJECTIVE
  Our aim was to increase physician awareness of cucurbitacin poisoning in order to facilitate accurate diagnosis and appropriate management.
  
  
  METHODS
  Five adult patients presented with nausea, vomiting, and diarrhea within 5 to 25 min of ingesting cooked bitter bottle gourd. One patient developed severe diarrhea, hematemesis, and hypotension requiring hospitalization. All patients improved within a few days with intravenous fluids and proton pump inhibitors. To our knowledge, this is the first reported group of patients with toxicity due to ingestion of bottle gourd in the United States (US).
  
  
  CONCLUSIONS
  Physicians should be suspicious of cucurbitacin toxicity in patients who present with symptoms within minutes of ingestion of a plant in the Cucurbitaceae family. Patients should be asked if the plant tasted unusually bitter. The most common symptoms include diarrhea and hematemesis. More than half of patients develop hypotension. There is no known antidote for bottle gourd poisoning; treatment is supportive. Proton pump inhibitors should be given to patients with gastrointestinal mucosal injury.
authors.affiliation: Los Angeles County + University of Southern California Medical Center, Departments of Internal Medicine and Pediatrics, University of Southern California, Los Angeles, California.
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Ho
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Ho
authors.affiliation: Henry Mayo Newhall Memorial Hospital, Newhall, California.
authors.forename: Shin-Pin
authors.initials: SP
authors.lastname: Ho
authors.affiliation: Department of Emergency Medicine, White Memorial Medical Center, Los Angeles, California.
authors.forename: Helen H
authors.initials: HH
authors.lastname: Ho
mesh_terms: D000368:Aged; D019662:Cucurbitaceae / Q000506:poisoning*; D054728:Cucurbitacins / Q000506:poisoning*; D003967:Diarrhea / Q000139:chemically induced; D005440:Fluid Therapy; D005517:Foodborne Diseases / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D014481:United States; D014839:Vomiting / Q000139:chemically induced
chemical_list: D054328:Proton Pump Inhibitors; D054728:Cucurbitacins
keywords: Cucurbitaceae; cucurbitacin; food poisoning; food-borne illness; hematemesis