The leaves of Cleistanthus collinus (CC) known as oduvanthazhai
in Tamil language is a commonly consumed plant poison in rural areas,
usually with a suicidal intention. Distal renal tubular acidosis is known
to occur with CC poisoning and hypokalemia is a risk factor for mortality
[1,2]. However, hypocalcemia in children with CC poisoning has not been
documented.
Two girls (12 years and 8 years of age) and their
brother (9 years) were brought to our hospital with alleged history of
consumption of 100-200 mL of boiled leaf extract of CC. Their mother had
given them the poison before consuming herself due to a family dispute.
They developed vomiting, drowsiness and breathing difficulty after an
hour. Gastric lavage was done in a nearby hospital after 4 hours of
consumption and brought to JIPMER after 48 hours of ingestion. The two
girls had polyuria, altered sensorium and shock while the boy was
hemodynamically stable. The eldest sibling had sinus bradycardia and
prolonged QTc. Blood investigations revealed severe metabolic acidosis,
hypokalemia, and hypocalcemia. However, the levels of urea, creatinine and
albumin were normal. Despite, mechanical ventilation and supportive care
including potassium replacement and inotropic support, the two girls had
cardiac arrest and died on the third and fourth day of hospitalization.
The intake of boiled leaf extract preparation
(increased concentration of plant glycosides) and the delay in gastric
lavage probably contributed to the death of the 2 girls [3]. The boy
probably survived owing to decreased amount ingested. Apart from metabolic
acidosis and hypokalemia, all three children had persistent hypocalcemia.
Hypercalciuria associated with distal renal tubular acidosis probably
contributed to the hypocalcemia. However, urinary calcium excretion could
not be documented. In addition to metabolic acidosis, hypocalcemia perhaps
contributed to myocardial dysfunction and mortality. In a child with CC
poisoning, it is prudent to watch for hypocalcemia and correct the same,
if present.
References
1. Nampoothiri K, Chrispal A, Begum A, Jasmine S,
Gopinath KG, Zachariah A. A clinical study of renal tubular dysfunction in
Cleistanthus collinus (Oduvanthalai) poisoning. Clin Toxicol (Phila).
2010; 48:193-7.
2. Shankar V, Jose VM, Bangdiwala SI, Thomas K.
Epidemiology of Cleistanthus collinus (oduvan) poisoning: clinical
features and risk factors for mortality. Int J Inj Contr Saf Promot. 2009;
16:223-30.
3. Subrahmanyam DK, Mooney T, Raveendran R, Zachariah
B. A clinical and laboratory profile of Cleistanthus collinus
poisoning. J Assoc Physicians India.2003; 51:1052-4.