Department of Emergency Medicine, University of Washington, 325 9th Avenue, Box 359702, Seattle, WA, 98104, USA.
Pediatric Critical Care Medicine, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way NE, Mailstop: FA.2.112, Seattle, WA, 98105, USA.
J Med Toxicol. 2019 Oct;15(4):295-298. doi: 10.1007/s13181-019-00727-w. Epub 2019 Aug 12.
A species of hawthorn, Crataegus mexicana (tejocote), has been marketed as a weight-loss supplement that is readily available for purchase online. While several hawthorn species have shown clinical benefit in the treatment of heart failure owing to their positive inotropic effects, little is known about hawthorn, and tejocote in particular, when consumed in excess. We describe a case of tejocote exposure from a weight-loss supplement resulting in severe cardiotoxicity.
A healthy 16-year-old girl presented to an emergency department after ingesting eight pieces of her mother's tejocote root weight-loss supplement. At arrival, she was drowsy, had active vomiting and diarrhea, and had a heart rate of 57 with normal respirations. Her initial blood chemistries were unremarkable, except for an elevated digoxin assay of 0.7 ng/mL (therapeutic range 0.5-2.0 ng/mL). All other drug screens were negative. She later developed severe bradycardia and multiple episodes of hypopnea that prompted a transfer to our institution, a tertiary pediatric hospital. Her ECG demonstrated a heart rate of 38 and Mobitz type 1 second-degree heart block. She was subsequently given two vials of Digoxin Immune Fab due to severe bradycardia in the setting of suspected digoxin-like cardiotoxicity after discussion with the regional poison control center. No clinical improvement was observed. Approximately 29 hours after ingestion, subsequent ECGs demonstrated a return to normal sinus rhythm, and her symptoms resolved.
Tejocote root toxicity may cause dysrhythmias and respiratory depression. Similar to other species of hawthorn, tejocote root may cross-react with some commercial digoxin assays, resulting in a falsely elevated level.
一种名为墨西哥山楂（tejocote）的山楂属植物被作为一种减肥补充剂进行销售，可在网上轻松购买。虽然由于正性肌力作用，几种山楂属植物在心力衰竭的治疗中显示出临床益处，但对于山楂属植物，尤其是tejocote，在过量食用时的情况知之甚少。我们描述了一例因食用减肥补充剂而导致严重心脏毒性的 tejocote 暴露病例。
一名 16 岁健康女孩因摄入其母亲的 8 片 tejocote 根减肥补充剂后，到急诊就诊。到达时，她嗜睡，有活跃的呕吐和腹泻，心率为 57 次/分，呼吸正常。她的初始血液化学检查无明显异常，除了地高辛检测值升高至 0.7ng/mL（治疗范围为 0.5-2.0ng/mL）。所有其他药物筛查均为阴性。后来，她出现严重心动过缓，多次出现呼吸暂停，这促使她转至我们的机构，一所三级儿科医院。她的心电图显示心率为 38 次/分，伴有 1 型莫氏 2 度房室传导阻滞。在与地区中毒控制中心讨论后，怀疑地高辛样心脏毒性，她因严重心动过缓，随后给予两剂地高辛免疫 Fab。没有观察到临床改善。摄入后约 29 小时，随后的心电图显示窦性节律恢复正常，症状缓解。
tejocote 根毒性可能导致心律失常和呼吸抑制。与其他山楂属植物类似，tejocote 根可能与一些商业地高辛检测发生交叉反应，导致检测值升高。
