Eddleston Michael, Haggalla Sapumal
Scottish Poisons Information Bureau, Royal Infirmary of Edinburgh, and Clinical Pharmacology Unit, University of Edinburgh, United Kingdom.
Clin Toxicol (Phila). 2008 Sep;46(8):745-8. doi: 10.1080/15563650701668617.
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.
We reviewed the post-mortem records of the Batticaloa Teaching Hospital and extracted data on all cases of fatal injury.
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.
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.
在南亚，食用植物种子或果实进行自我中毒是一种常见的自我伤害方式。虽然大多数死亡是由于摄入了黄花夹竹桃种子，但其他植物在当地也很常见。在对斯里兰卡东部一家教学医院所见的致命伤进行回顾时，我们注意到了海芒果果实导致致命自我中毒的病例。
我们回顾了拜蒂克洛教学医院的尸检记录，并提取了所有致命伤病例的数据。
2001年至2002年期间，拜蒂克洛教学医院进行了315例损伤尸检。故意自我伤害占病例的48.6%。黄花夹竹桃导致33人死亡，而海芒果自我中毒导致7人死亡。海芒果中毒病例具有强心苷中毒的典型特征，伴有心律失常和高钾血症。在没有起搏设备和抗地高辛Fab片段的情况下，治疗措施包括使用阿托品以及胰岛素和葡萄糖来降低血清钾浓度。
海芒果自我中毒此前仅在印度南部的喀拉拉邦和泰米尔纳德邦有报道。虽然在斯里兰卡其他地区不常见，但在东海岸的一个地区，它已成为一种常见的自我伤害方式，在一家医院中占植物导致致命自我伤害病例的20%。现有的资源不足以进行治疗，这凸显了需要一种价格合理的植物强心苷中毒抗毒素。
