Yam bean seed poisoning mimicking cyanide intoxication*

Acute rotenone poisoning: A scoping review

Context

Rotenone is a toxic chemical found in various plants, including some used as food. Rotenone poisoning can be fatal and there is no antidote. Mechanistically, rotenone inhibits mitochondrial complex I, leading to reduced ATP production, compensatory glycolytic upregulation and secondary lactate production, and oxidative stress. Our literature review examined acute rotenone poisoning in humans, including exposure scenarios, clinical presentations, and treatments.

Methods

We searched five databases for relevant literature from database inception through the search date: July 12, 2022, pairing controlled vocabulary and keywords for "rotenone" with terms relating to human exposures and outcomes, such as "ingestion," "exposure," and "poisoning." We included all peer-reviewed reports found using the search terms where the full English text was available. Data abstracted included the number, age, weight, and sex of the exposed person(s), country where exposure happened, exposure scenario, ingestion context, estimated dose, clinical features, whether hospitalization occurred, treatments, and outcomes.

Results

After removing non-qualifying sources from 2,631 publications, we identified 11 case reports describing 18 victims, 15 of whom were hospitalized and five died. Most cases occurred in private quarters where victims unknowingly consumed rotenone-containing plants. Vomiting and metabolic acidosis occurred most commonly. Some patients exhibited impaired cardiopulmonary function. Supportive treatment addressed symptoms and included gastric lavage and/or activated charcoal to remove rotenone from the stomach, vasopressors for hypotension, mechanical ventilation for respiratory insufficiency, and sodium bicarbonate for acidosis. Some patients received N-acetylcysteine to counter oxidative stress.

Conclusions

Rotenone poisoning, though rare, can be fatal. Exposure prevention is impractical since rotenone is found in some plants used as food or pesticides. Cases may be under-diagnosed because symptoms are non-specific and under-reported in English-language journals since most cases occurred in non-English speaking countries. Treatments are supportive. Exploring antioxidant therapy in animal models of rotenone poisoning may be indicated considering rotenone's mechanism of toxicity.

A case of rotenone poisoning from ingesting Derris trifoliata Lour. (Tuba fruit/pod) in Malaysia

Derris trifoliata is mainly found in mangrove area in tropical regions and the plant extract is traditionally used for fishing by poisoning. This is the first case report of rotenone poisoning in a child from ingesting Derris trifoliata seed. The child developed altered consciousness, vomiting, hypotension, metabolic acidosis, and acute kidney injury. Species identification of this case requires the collaborative efforts of various agencies. She survived from the poisoning with no neurological sequelae.

The Bioactivity and Phytochemicals of Pachyrhizus erosus (L.) Urb.: A Multifunctional Underutilized Crop Plant

Pachyrhizus erosus (L.) Urb. is an underutilized crop plant belonging to the Fabaceae family. In recent years, the plant received huge attention and was introduced in different countries owing to properties such as a high nutritional content, its nitrogen-fixing abilities, and different biological activities such as its antioxidant, immune modulation, anticancer, anti-diabetes, anti-osteoporosis, antiviral, and antiaging affects, among others. In this review, an attempt has been made to comprehensively compile the biological activities of the plant to provide a panoramic view of the current efforts and further directions, which may lead to the development of pharmacological applications. This information will be helpful in creating interest towards P. erosus and it may be useful in developing the plant for medical applications and/or as a functional food. More than 50 phytochemicals have been reported from the plant, which belong to different chemical classes such as triterpenoids, organic acid, flavonoids, and fatty acids. Numerous biological activities were reported from the plant through in vivo, in vitro, ex vivo, and human studies. However, well-defined clinical studies are still lacking for the establishment of any biological properties that could be further developed. Suggestions for the further development of P. erosus, according to current knowledge about the different biological properties, has also been provided.

A Poisoning Outbreak Caused by Millettia Pachycarpa - Chongqing Municipality, December 2020

What is already known about this topic?

Millettia pachycarpa belongs to the Fabaceae family and is widely distributed in the southern China. It is toxic for the rotenone contained in its roots and seeds, and ingesting its seeds could result in poisoning.

What is added by this report?

In December, 2020, a poisoning from plant seeds occurred in Chongqing Municipality. The etiological association was confirmed based on epidemiological investigation, clinical manifestation, plant species identification, and rotenone analysis. The patient rapidly developed central nervous and respiratory depression with metabolic acidosis. The plant was identified as Millettia pachycarpa, and toxin analysis indicated that the rotenone content contained in the seeds was high enough to cause intoxication.

What are the implications for public health practice?

Millettia pachycarpa poisoning is rare but could be fatal. Efforts should be made to educate and communicate with the public, doctors, and public health practitioners that the toxic effects the seeds could be life-threating when swallowed, both accidentally or intentionally.

Food derived respiratory complex I inhibitors modify the effect of Leber hereditary optic neuropathy mutations

Mitochondrial DNA mutations in genes encoding respiratory complex I polypeptides can cause Leber hereditary optic neuropathy. Toxics affecting oxidative phosphorylation system can also cause mitochondrial optic neuropathy. Some complex I inhibitors found in edible plants might differentially interact with these pathologic mutations and modify their penetrance. To analyze this interaction, we have compared the effect of rotenone, capsaicin and rolliniastatin-1 on cybrids harboring the most frequent Leber hereditary optic neuropathy mutations and found that m.3460G > A mutation increases rotenone resistance but capsaicin and rolliniastatin-1 susceptibility. Thus, to explain the pathogenicity of mitochondrial diseases due to mitochondrial DNA mutations, their potential interactions with environment factors will have to be considered.

Rotenone Analysis by Liquid Chromatography-Tandem Mass Spectrometry with Information-Dependent Acquisition in a Fatal Case of Rotenone Poisoning with a Commercial Organic Insecticide Being Sold in Korea

Rotenone is a neurotoxin derived from Derris roots or yam bean of genus Derris or Lonchocarpus It is known to cause Parkinson-like symptoms and is a potent electron transport inhibitor. Rotenone was detected in postmortem specimens in a fatal case of rotenone poisoning with an organic pesticide by liquid chromatography-tandem mass spectrometry with an information-dependent acquisition and MS-MS library search. The forensic specimens were prepared by solid-phase extraction with a Bond Elut(®) Certify cartridge. The mobile phase comprised 5 mM ammonium formate in 10% methanol and 5 mM ammonium formate in 90% methanol. The assay was linear over the range from 0.01 to 1.0 mg/L (r(2) = 0.995). The limit of detection and quantitation in the blood were 0.001 mg/L (signal-to-noise, S/N = 3) and 0.003 mg/L (S/N = 10), respectively. The intraday accuracy and precision for rotenone that were determined by five replicates at 0.02, 0.10 and 1.0 mg/L in blood were <15.0% of bias and <9.0% of CV, respectively. The interday accuracy and precision for rotenone that were determined by seven replicates at 0.02, 0.10 and 1.0 mg/L in blood were <18.0% of bias and <17.0% of CV, respectively. Relative recovery with 0.02, 0.1 and 1.0 mg/L in blood was 104.2, 103.3 and 81.6% (n = 6), respectively. The described method was applied for the determination of rotenone in a fatal case of intoxication of a 33-year-old man who was found dead on a bed in a temporary house. In this case study, the concentrations of rotenone in heart blood (HB), peripheral blood (PB), gastric contents and vitreous humor were 0.77 mg/L, 0.02 mg/L, 126.4 mg/kg and 0.003 mg/L, respectively. The rotenone concentration ratio of the HB/PB was 38.8 and that of gastric contents/PB was 6412.3, suggesting a massive ingestion of rotenone with postmortem redistribution. This study is the report of rotenone detection in a fatal case with the ingestion of the organic insecticide containing rotenone.

Fast method for the simultaneous quantification of toxic polyphenols applied to the selection of genotypes of yam bean (Pachyrhizus sp.) seeds

The purpose of the research was to develop and validate a rapid quantification method able to screen many samples of yam bean seeds to determine the content of two toxic polyphenols, namely pachyrrhizine and rotenone. The analytical procedure described is based on the use of an internal standard (dihydrorotenone) and is divided in three steps: microwave assisted extraction, purification by solid phase extraction and assay by ultra high performance liquid chromatography (UHPLC). Each step was included in the validation protocol and the accuracy profiles methodology was used to fully validate the method. The method was fully validated between 0.25 mg and 5 mg pachyrrhizin per gram of seeds and between 0.58 mg/g and 4 mg/g for rotenone. More than one hundred samples from different accessions, locations of growth and harvest dates were screened. Pachyrrhizine concentrations ranged from 3.29 mg/g to lower than 0.25 mg/g while rotenone concentrations ranged from 3.53 mg/g to lower than 0.58 mg/g. This screening along with principal component analysis (PCA) and discriminant analysis (DA) analyses allowed the selection of the more interesting genotypes in terms of low concentrations of these two toxic polyphenols.

Degradation of rotenone in yam bean seeds ( Pachyrhizus sp.) through food processing

The purpose of this research is to screen different processes that could potentially decrease or even eliminate rotenone, a toxic isoflavonoid, from Pachyrhizus seeds. Yam bean seeds have very interesting nutritional characteristics, especially their high protein and lipid contents, and could potentially increase food security in under-nourished populations. However, they contain rotenone, a natural molecule previously used as an insecticide inhibiting the respiratory mitochondrial chain. It was also proven to be toxic to mammals as chronic exposure leads to the development of Parkinson-like symptoms in rats. As the thermosensitivity of rotenone had been reported, this study tested different processes (drying, roasting, boiling, frying, alcohol extraction), tegument removal, and traditional Beninese culinary recipes. Rotenone was then quantified in end-products by a validated method, associating microwave extraction, solid phase extraction (SPE), and HPLC-UV. With these processes a rotenone removal of up to 80% was obtained. The most effective methods were the drying and roasting of the seeds and the maceration of their flour in local alcohol. Rotenone degradation and elimination were confirmed by cytotoxic assays, effectively inducing a decrease in sample toxicity.

Toxic leukoencephalopathy due to yam bean seeds poisoning

Toxic leukoencephalopathy is attributed to exposure to a wide variety of agents, including systemic chemotherapy, cranial irradiation, illicit drug abuse, and toxins from the environment. Diagnosis of this disease requires documented exposure to a toxin, neurobehavioral deficits, and typical neuroimaging abnormalities. Intoxication by compounds extracted from yam bean seeds may mimic cyanide poisoning but fail to respond to antidotal therapy. We report a 54-year-old Chinese woman who developed disturbed consciousness after eating 40 pieces of yam bean seeds. Head computed tomography obtained 24 hours after the episode was normal. However, magnetic resonance imaging obtained 20 days after the episode revealed symmetrical faint high signal over the bilateral periventricular white matter on T1-weighted image, which turned into diffuse and symmetrical bright high signal on FLAIR. The diagnosis of this patient was toxic leukoencephalopathy by yam bean seeds intoxication. The changes in brain images after yam bean seeds intoxication have not ever been reported. Physicians in Asia and the Pacific islands should have a high index of suspicion when they care for patients with acute confusion and a high anion gap metabolic acidosis but normal serum cyanide level.

Suicide attempt by ingestion of rotenone-containing plant extracts: one case report in French Guiana

INTRODUCTION

Several species of plants in the Fabaceae family are traditionally used for poison fishing because they contain ichthyotoxic rotenoids. In French Guiana two species of Fabaceae belonging to Lonchocarpus genus with a toxic rotenone effect are used for such ancestral practices. Rotenone is of low toxicity for humans when it is diluted, but its neurotoxicity at higher concentrations is well known to users.

CASE REPORT

The purpose of this article is to describe a case of self-poisoning by an 86-year-old woman who ingested a bowl of mashed ichthyotoxic plants. Despite early onset of severe symptoms, the patient regained consciousness and resumed normal breathing within a few hours with only symptomatic treatment.

CONCLUSION

The clinical pattern observed in this patient (onset of digestive manifestations followed quickly by loss of conscience and respiratory insufficiency) is in agreement with the few poisonings reported in the literature involving other Fabaceae species containing rotenoids in Asia or involving concentrated rotenone used in insecticides. In patients, who survive the initial phase, symptoms usually regress quickly.