title: Cleistanthus collinuspoisoning: experience at a medical intensive care unit in a tertiary care hospital in south India.
abstract: OBJECTIVE
  Ingestion of Cleistanthus collinus causes hypokalemia and cardiac arrhythmias leading to mortality in most cases. We undertook this retrospective study to evaluate the clinical presentation and predictors of outcome in critically ill patients admitted with C. collinus poisoning.
  
  
  METHODS
  The case records of 56 patients admitted to the medical intensive care unit (MICU) of a tertiary care teaching hospital in south India (2000-2014) with C. collinus poisoning were retrospectively analysed.
  
  
  RESULTS
  The mean age of patients was 36.7±13.3 yr; there were 30 males. Salient clinical manifestations included hypokalemia (58%), neutrophilic leucocytosis (48.2%), acute kidney injury (AKI) (42.9%), acute respiratory failure requiring mechanical ventilation (AcRFMv) (32.1%), shock (21.4%); cardiac arrhythmias and neuromuscular weakness (19.6% each); 21 patients (37.5%) had adverse outcome. Longer time-lapsed from consumption to reaching emergency room [median (interquartile range)] (hours) [49 (22-97) vs. 28 (7-56), p =0.0380 ]; higher acute physiology and chronic health evaluation II (APACHE II) score at presentation [14 (8.25-14.75) vs. 2 (0-6) P<0.001]; and presence of the following [odds ratio (95% confidence intervals)] at initial presentation: shock [37.40 (4.29-325.98), P=0.001]; AcRFMv [26.67 (5.86-121.39), P<0.001]; elevated alanine aminotransferase [5.71 (1.30-25.03), p0 =0.021]; metabolic acidosis [5.48 (1.68-17.89), P=0.005]; acute kidney injury (AKI) [5 (1.55-16.06), P=0.007]; hyponatremia [4.67 (1.25-17.44), P=0.022]; and neutrophilic leucocytosis [3.80 (1.02-14.21), P=0.047] predicted death. A significant (P<0.001) increasing trend in mortality was observed with increasing International Program on Chemical Safety Poisoning Severity Score (IPCS-CSS) grade.
  
  
  CONCLUSIONS
  C. collinus is a lethal poison associated with high mortality for which there is no specific antidote. Careful search and meticulous monitoring of the predictors of death and initiating appropriate corrective measures can be life saving.
authors.affiliation: The Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Sri Venkateswara Institute of Medical Sicences, Tirupati, India.
authors.forename: Alladi
authors.initials: A
authors.lastname: Mohan
authors.affiliation: The Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Sri Venkateswara Institute of Medical Sicences, Tirupati, India.
authors.forename: G Sivaram
authors.initials: GS
authors.lastname: Naik
authors.affiliation: The Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Sri Venkateswara Institute of Medical Sicences, Tirupati, India.
authors.forename: J
authors.initials: J
authors.lastname: Harikrishna
authors.affiliation: The Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Sri Venkateswara Institute of Medical Sicences, Tirupati, India.
authors.forename: D Prabath
authors.initials: DP
authors.lastname: Kumar
authors.affiliation: Department of Anesthesiology & Critical Care Medicine, Sri Venkateswara Institute of Medical Sicences, Tirupati, India.
authors.forename: M H
authors.initials: MH
authors.lastname: Rao
authors.affiliation: Department of Statistics, Sri Venkateswara University, Tirupati, India.
authors.forename: Kvs
authors.initials: K
authors.lastname: Sarma
authors.affiliation: Section of Pulmonary Critical Care & Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: K K
authors.initials: KK
authors.lastname: Guntupalli
mesh_terms: D058186:Acute Kidney Injury / Q000503:physiopathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000503:physiopathology*; D019665:Euphorbiaceae / Q000633:toxicity*; D005260:Female; D006801:Humans; D007008:Hypokalemia / Q000503:physiopathology*; D007194:India; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010939:Plant Poisoning / Q000503:physiopathology*; D012720:Severity of Illness Index; D062606:Tertiary Care Centers