title: The syndrome of inappropriate antidiuretic hormone secretion after giant leaf frog (Phyllomedusa bicolor) venom exposure.
abstract: BACKGROUND
  In Europe body purification and natural balance restoring rituals are becoming increasingly popular, but an introduction of Amazonian shamanic rituals in urban Europe can result in unexpected adverse events.
  
  
  METHODS
  A 44-year-old woman attended a Kambô or Sapo ritual in Slovenia where dried skin secretion from a giant leaf frog (Phyllomedusa bicolor) was applied to five freshly burned wounds at her shoulder. Afterwards, she drank 6 litres of water and gradually developed nausea and vomiting, confusion, lethargy, muscle weakness, spasms and cramps, seizure, decreased consciousness level and short-term memory loss. The initial laboratory tests showed profound plasma hypoosmolality (251 mOsm/kg) proportional to hyponatremia (116 mmol/L) combined with inappropriately elevated urine osmolality (523 mOsm/kg) and high urine sodium concentration (87 mmol/L) indicating a syndrome of inappropriate antidiuretic hormone secretion. The patient was treated with 0.9% sodium chloride and a restriction of water intake. Plasma osmolality and hyponatremia improved one day after venom exposure, but the symptoms disappeared as late as the third day.
  
  
  CONCLUSIONS
  In patients presenting with neurological symptoms and a line of small body burns Phyllomedusa bicolor venom exposure should be suspected. Acute symptomatic hyponatremia after Phyllomedusa bicolor venom exposure is the result of inappropriate antidiuretic hormone secretion that can be exacerbated by excessive water intake.
authors.affiliation: Centre for Clinical Toxicology and Pharmacology, Division of Internal Medicine, University Medical Centre Ljubljana, Zaloška cesta 7, 1000, Ljubljana, Slovenia. Electronic address: vid.leban@kclj.si.
authors.forename: Vid
authors.initials: V
authors.lastname: Leban
authors.affiliation: Institute of Forensic Medicine, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia. Electronic address: gordana.kozelj@mf.uni-lj.si.
authors.forename: Gordana
authors.initials: G
authors.lastname: Kozelj
authors.affiliation: Centre for Clinical Toxicology and Pharmacology, Division of Internal Medicine, University Medical Centre Ljubljana, Zaloška cesta 7, 1000, Ljubljana, Slovenia; Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Zaloška cesta 4, Ljubljana, Slovenia. Electronic address: miran.brvar@kclj.si.
authors.forename: Miran
authors.initials: M
authors.lastname: Brvar
mesh_terms: D000328:Adult; D000664:Amphibian Venoms / Q000008:administration & dosage* / Q000009:adverse effects; D000818:Animals; D001001:Anura; D005260:Female; D006801:Humans; D007177:Inappropriate ADH Syndrome / Q000139:chemically induced*
chemical_list: D000664:Amphibian Venoms
keywords: Hyponatremia; Phyllomedusa bicolor; Poisoning; Primary polydipsia; SIADH; Seizures