Anderson I B, Mullen W H, Meeker J E, Oishi S, Nelson S D, Blanc P D
San Francisco Bay Area Regional Poison Control Center, San Francisco General Hospital, CA 94110, USA.
Ann Intern Med. 1996 Apr 15;124(8):726-34. doi: 10.7326/0003-4819-124-8-199604150-00004.
Pennyroyal is a widely available herb that has long been used as an abortifacient despite its potentially lethal hepatotoxic effects. However, quantitative data for pennyroyal constituents and their metabolites in humans have not been previously reported.
To quantify pennyroyal metabolites in human overdose, to correlate these findings with clinical variables, and to place these findings in the context of previously reported cases of pennyroyal toxicity.
Clinical case series of pennyroyal ingestions; quantification of pennyroyal metabolites by gas chromatography and mass spectrometry; qualitative detection of protein-bound adducts of the metabolites of pennyroyal constituents in human liver by Western blot assay; and review of the literature based on a search of MEDLINE, Index Medicus, and the reference citations of all available publications.
We report four cases of pennyroyal ingestion. One patient died, one received N-acetylcysteine, and two ingested minimally toxic amounts of pennyroyal and were not treated with N-acetylcysteine. In the fatal case, postmortem examination of a serum sample, which had been obtained 72 hours after the acute ingestion, identified 18 ng of pulegone per mL and 1 ng of menthofuran per mL. In a serum sample from the patient treated with N-acetylcysteine, which had been obtained 10 hours after ingestion, the menthofuran level was 40 ng/mL. Review of 18 previous case reports of pennyroyal ingestion documented moderate to severe toxicity in patients who had been exposed to at least 10 mL of pennyroyal oil.
Pennyroyal continues to be an herbal toxin of public health importance. Data on human metabolites may provide new insights into the toxic mechanisms and treatment of pennyroyal poisoning, including the potential role of N-acetylcysteine. Better understanding of the toxicity of pennyroyal may also lead to stricter control of and more restricted access to the herb.
薄荷油是一种广泛可得的草药，尽管其具有潜在的致命肝毒性作用，但长期以来一直被用作堕胎药。然而，此前尚未报道过人类体内薄荷油成分及其代谢物的定量数据。
对过量服用薄荷油的人体内的薄荷油代谢物进行定量分析，将这些发现与临床变量相关联，并将这些发现置于此前报道的薄荷油中毒病例的背景下。
薄荷油摄入的临床病例系列；通过气相色谱和质谱法定量分析薄荷油代谢物；通过蛋白质印迹法对人肝脏中薄荷油成分代谢物的蛋白质结合加合物进行定性检测；以及基于对医学文献数据库（MEDLINE）、医学索引（Index Medicus）的检索以及所有可用出版物的参考文献进行文献综述。
我们报告了4例薄荷油摄入病例。1例患者死亡，1例接受了N - 乙酰半胱氨酸治疗，另外2例摄入了毒性较小剂量的薄荷油且未接受N - 乙酰半胱氨酸治疗。在致命病例中，急性摄入72小时后采集的一份血清样本尸检显示，每毫升含有18纳克的长叶薄荷酮和1纳克的薄荷呋喃。在摄入10小时后采集的接受N - 乙酰半胱氨酸治疗患者的一份血清样本中，薄荷呋喃水平为40纳克/毫升。对之前18例薄荷油摄入病例报告的回顾表明，接触至少10毫升薄荷油的患者出现了中度至重度毒性。
薄荷油仍然是一种具有公共卫生重要性的草药毒素。关于人体代谢物的数据可能为薄荷油中毒的毒性机制和治疗提供新的见解，包括N - 乙酰半胱氨酸的潜在作用。对薄荷油毒性的更好理解也可能导致对该草药进行更严格的管控和限制获取。
