1. Fatal plant poisoning in Kasturba hospital, Manipal Pinakini KS , Mohan Kumar TS , Vikram Palimar , Pradeep Kumar G   Dept of Pharmacology, MMMC, Manipal  Dept of Forensic Medicine, KMC,Manipal

2. Introduction  Plant poisoning may be accidental, self induced, or homicidal  Diagnosis is difficult / impossible  Clinical features mimic natural disease  Lack of knowledge of plants  Different nomenclatures

3. Materials and Methods  A 12 year retrospective study (1993-2004)  Hospital records  Autopsy reports  FSL reports

4. Profile of poisoning deaths TypeNo. of cases% Organophosphorus24465.5 Organochlorines267.1 Carbamate174.6 Zinc phosphide123.2 Copper sulphate123.2 Medicinal drugs92.4 Alcohol61.6 Plants61.6 Corrosives71.9 Mixed82.1 Others112.9 3.8 Unknown14 Total372100

5. Clinical profile Age/sexPlantPulse/min BP 1. 37yr-MCerbera thevetia 2 seeds 70120/70 2. 22yr-F 3. 55yr-M 4. 30yr-F Cerbera thevetia 2 seeds Cerbera odollum fruit 60 82 32 94/60 180/100 80/60

6. Clinical profile Period of survivalECG 1. 37yr-M18 hrsSinus Nodal Dysfunction 2.22yr-F 3. 55yr-M 4. 30yr-F 10 hrs 60 hrs 10 hrs AV dissociation Normal AV dissociation

7. Lab parameters CaseK+ mEq/ Urea mg/dl Creatinine mg/dl Bilirubin mg/dl AST U/l ALT U/l 18.8242.21.35332 24300.91.14628 34.2470.8 4621 44.5281.10.74036 * Sahu et al, ‘ Yellow oleander poisoning with jaudice & renal failure’. JAPI 1989

8. Treatment  Gastric lavage  Inj atropine: bradyarrythmias  Temporary pacemaker: femoral vein  Phenytoin / lignocaine: tachyarrythmias

9. Autopsy findings  Congestion of GI tract  Brain congested & edematous  Heart - Subendocardial haemorhages  Kidneys bilaterally congested  FSL-Cardiac glycosides in the viscera

10. Discussion  Cardiac glycosides: Cerbera thevetia & odollum  Apocynaceae  Active principles: cerberin, odolin, thevetin & thevotoxin  Accidental in children  Suicidal/homicidal: adults  Cardiac manifestations

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