Cardiac glycoside poisoning following suicidal ingestion ofCerbera manghas

Bintaro (Cerbera odollam and Cerbera manghas): an overview of its eco-friendly use, pharmacology, and toxicology

Bintaro is a tropical mangrove plant often used as a shade tree found in Asia, Australia, Madagascar, and the Islands of the Western Pacific Ocean. The word Bintaro is also often pinned to its closest relative species, the Cerbera odollam. Flower color is one of the distinguishing features between these two species. Human poisoning with the cardiotoxic plant Bintaro is common in Southeast Asia because it bears a fruit that yields a powerful poison that has been used for suicide and homicide, hence it is also called the "Indian suicide tree". The seeds of Bintaro contain Cerberin, a cardiac glycoside toxin of the heart that blocks the calcium ion channels in heart muscles, resulting in disruption of the heartbeat most often fatally. The bio-active compound in the kernels of Bintaro varies due to which plant possesses other properties as well. The plant may also be used for medicinal purposes as it shows many pharmaceutical properties. The seeds of the plant have auspicious anticancer properties through apoptotic activity and the leaf extract of the plant was screened for its antioxidant activities. In addition, it is also used as an insecticide, pesticide, or antifungal agent. This review highlights the Pharmaceutical, toxicological, and environmentally friendly approaches of Bintaro.

Cerbera odollam: A Case Report of Attempted Suicide by Pong Pong

Cerbera odollam, commonly referred to as the "suicide tree" or "pong pong," produces highly toxic seeds that are used for suicidal and homicidal purposes. It is important that western physicians be aware of the symptoms associated with these seeds and how to diagnose and treat them.

Study on Clinical Profile and Predictors of Mortality in Cerbera odollam Poisoning

Context:

Cerbera odollam is a tree native to South Asia. It belongs to the poisonous Apocynaceae family. Deliberate self-harm with fruit of this plant is a major clinical problem in the developing world. Ingestion of C. odollam kernels is the cause of deaths in more than half of Kerala's plant poisoning deaths. The data on clinical features and complications of C. odollam poisoning are sparse, apart from a few case reports and limited studies.

Aims:

The present study was done to find the mode of presentation, complications, need for cardiac pacing, inhospital mortality, and the predictors of mortality in patients with C. odollam poisoning.

Settings and Design:

This was a retrospective study conducted in the department of general medicine in a tertiary care center in Alappuzha district, Kerala. The study period was for 1 year from January 1, 2016, to December 31, 2016.

Subjects and Methods:

All the patients admitted with a history of ingestion of odollam during the study period were included in the study. Data were collected from case records. The study was approved by the institutional ethics committee and research committee (IEC/TDMCA/EC3.dated29/11/201).

Statistical Analysis Used:

The data were analyzed using SPSS 16 for Windows (SPSS Inc., Chicago, IL, USA).

Results:

In this study, 102 patients were identified with C. odollam poisoning, and the mortality rate was 16.7%. Electrocardiogram (ECG) changes were common in our patients, and we observed different types of heart block in the same ECG itself. Ingestion of more than two kernels of odollam, late presentation to hospital, vomiting, bradycardia, hypotension, hyperkalemia, and more severe ECG changes were associated with significantly higher mortality in this study.

Conclusions:

C. odollam poisoning is a common method of deliberate self-harm in Kerala. It carries a high mortality rate, and the predictors of mortality include vomiting, bradycardia, hypotension, hyperkalemia, and the presence of severe ECG changes.