Document Detail

Fatal injury in eastern Sri Lanka, with special reference to cardenolide self-poisoning with Cerbera manghas fruits.
MedLine Citation:
PMID:  18803087     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Self-poisoning with plant seeds or fruits is a common method of self-harm in South Asia. While most deaths follow ingestion of Thevetia peruviana (yellow oleander) seeds, other plants are locally common. During review of fatal injuries seen in a teaching hospital in eastern Sri Lanka, we noted cases of fatal self-poisoning with Cerbera manghas (sea mango, pink eyed cerbera, odollam tree) fruits. METHODS: We reviewed the post-mortem records of the Batticaloa Teaching Hospital and extracted data on all cases of fatal injury. RESULTS: During 2001 and 2002, 315 post mortems for injury were performed in Batticaloa Teaching Hospital. Intentional self-harm was responsible for 48.6% of cases. While T. peruviana was responsible for 33 deaths, C. manghas self-poisoning caused seven deaths. C. manghas cases had typical features of cardenolide poisoning with cardiac dysrhythmias and hyperkalemia. In the absence of pacing facilities and anti-digoxin Fab, management involved administration of atropine and of insulin and dextrose to lower serum potassium concentrations. CONCLUSIONS: C. manghas self-poisoning has only previously been reported from Kerala and Tamil Nadu in south India. While uncommon in other parts of Sri Lanka, it has become a common method of self-harm in one east coast district, accounting for 20% of fatal self-harm with plants in one hospital. Management was inadequate with the available resources, emphasising the need for an affordable antitoxin for plant cardenolide poisoning.
Michael Eddleston; Sapumal Haggalla
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical toxicology (Philadelphia, Pa.)     Volume:  46     ISSN:  1556-3650     ISO Abbreviation:  Clin Toxicol (Phila)     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2009-02-24     Completed Date:  2009-03-05     Revised Date:  2009-11-17    
Medline Journal Info:
Nlm Unique ID:  101241654     Medline TA:  Clin Toxicol (Phila)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  745-8     Citation Subset:  AIM; IM    
Scottish Poisons Information Bureau, Royal Infirmary of Edinburgh, and Clinical Pharmacology Unit, University of Edinburgh, United Kingdom.
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MeSH Terms
Antidotes / therapeutic use
Apocynaceae / poisoning*
Atropine / therapeutic use
Cardenolides / poisoning*
Cardiotonic Agents / therapeutic use
Fatal Outcome
Fruit / poisoning
Glucose / therapeutic use
Insulin / therapeutic use
Isoproterenol / therapeutic use
Medical Records
Overdose / drug therapy,  epidemiology
Seeds / poisoning*
Sri Lanka / epidemiology
Suicide / statistics & numerical data
Grant Support
071669MA//Medical Research Council; //Wellcome Trust
Reg. No./Substance:
0/Antidotes; 0/Cardenolides; 0/Cardiotonic Agents; 11061-68-0/Insulin; 50-99-7/Glucose; 51-55-8/Atropine; 7683-59-2/Isoproterenol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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