MULTI ORGAN DYSFUNCTION FOLLOWING CONSUMPTION OF TUBERS OF GLORIOSA SUPERBA : A RARE CASE REPORT

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ABOUT AUTHORS
^*K. Vinod¹, B, Dr. N. Surendra Reddy¹,Dr. K. Chandra Sekhar², Dr. D. Ranganayakulu^1
1Department of Pharmacy Practice,
Sri Padmavathi School of Pharmacy,
Tiruchanoor, Tirupati, India.
² Department of General Medicine,
Sri Venkateswara Medical College,
Tirupati, Andhra Pradesh, India .
*drvinodkatiboina@gmail.com

ABSTRACT:
A 25 years married man was admitted on to emergency acute medical care unit. He had fallen ill after an afternoon meal from 4 days ago which consisted of rice and 3 tubers identified as gloriosa superb. About 3hrs after the ingestion, he developed abdominal pain, vomiting (15-20 episodes), and watery diarrhoea 15-20 episodes. He developed bleeding gums, yellowish discoloration, hematemesis 30-50 ml, 24episodes, haematuria, decreased urine output along with continued diarrhoea and vomiting. He was treated with iv fluids crystalloids and colloids titrated, 1 fresh frozen plasma (FFP), 1fresh platelet transfusion, inj. vit K, supportive treatment with close monitoring of vitals. Therapy as planned for ventilator support, however had ever had bleeding per rectum and hematemesis with aspiration, even with best available resuscitative efforts he succumbed to his illness and declared clinically dead after 36hrs of admission, his cause of death was given as multiorgan dysfunction see to gloriosa superb. Though poisoning with gloriosasuperba is rare it is mostly fatal and requires aggressive and prompt treatment is mandatory from saving the patient from death.

REFERENCE ID: PHARMATUTOR-ART-2515

INTRODUCTION:
Gloriosa superb is a climbing hedge plant growing all over India mostly in southern part, also known by name glory lily, flame lily, pulasapadupappugadda, gharbainatin in Sanskrit meaning which cause abortion.

A medicinal plant cultivated for colchicines used for various ailments like Joint pains.Colie, antifertility, abortifacient, leprosy, anthelminthic, gonorrhoea to name to afew.

Zimbabwe has declared gloriosa as national flower and tamilnadu as state flower. Fresh tubers are more poisonous contains 6mg of colchicines per 10grams of tuber,also have other alkaloids gloriosine and resins.
Primary actions of gloriosa are:
1. Blocks mitosis at metaphase in dividing cells especially GI tract,bone marrow.
2. Reduction of neutrophils migration,phagocytosis,adhesion and chemo taxi
3. Negative inotropic effects,decreased calcium myofilaments sensitivity decreased sarcoplasmic reticular on cardiac muscle.
4. Neurotoxicity by decreased function axonal transport and vesicle release

Clinical features can be divided into

Treatment includes
Gastic lavage with activated charcoal,large volume of crystalloids and colloids, FFP,platelet ,blood transfusions,inotropic support for cardiogenics and circulatory shock,treatment of electrolyte imbalance,GM-CSF for pancytopenia,mechanical ventilation for ADRS with O2 inhalation, antibiotics for sepsis,dialysis for renal failure.since alopecia and azoospermis are reversible wait and watch therapy is used.reports of colchicines specific fab are published but availablility,success rate are to be measured.

Case report:
A 25 years married man was admitted on to emergency acute medical care unit of S.V.R.R.G.H,Tirupati,Andra Pradesh. He had fallen ill after an afternoon meal from 4 days ago which consisted of rice and 3tubers identified as gloriosa superb. The colchicine content of the fresh tubers was 0.3%. Total amount consumed was of 300gm of tuber with colchicines 180 mg.

About 3hrs after the ingestion, he developed abdominal pain, vomiting (15-20 episodes), and waterydiarrhoea 15-20 episodes. He was treated at a local hospital for 4 days and referred to our hospital. He developed bleeding gums, yellowish discoloration, hematemesis 30-50 ml,24episodes, haematuria,decreased urine output along with continued diarrhoea and vomiting.

On examination he was conscious,restless, dehydrated with toxic took,pulse rate 108, moderate volume in sinus rhythm, B.P 100/70 mmofHg,R.R of 18/m,general examination showed pallor, icterus,mild pedal oedema, bleeding gums, non palpablepurpura, echymotic patches on both upperlimbs, subconjuctival hemorrhage. Lungs showed fine inspiratory crepitations, tachycardia. Abdominal examination revealed diffuse tenderness, mild distension, hepatomegaly with respiratory seizures examination, 3cms below ICM, soft .tender with sluggish bowel sounds.

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Investigations revealed   

He was treated with iv fluids crystalloids and colloids titrated,1 fresh frozen plasma (FFP),1fresh platelet transfusion,inj.vit k, supportive treatment with close monitoring of vitals.next day he developed heavy about of hemetemisis 200ml fresh blood,anuria past 12 hours,vitals showed PR 124/min,B.P 80/60mmof Hg,tachypnoea, spo2 of 74% with 6lts of O2,was put on inotrope support nor adrenaline and dopamine titrated to his vitals.1FFP was transfused along with 1packet of blood. Investigations showed following

Therapy as planned for ventilator support, however had ever had bleeding per rectum and hematemesis with aspiration, even with best available resuscitative efforts he succumbed to his illness and declared clinically dead after 36hrs of admission, his cause of death was given as multiorgan dysfunction see to gloriosa superb.

Conclusion: Though poisoning with gloriosa superb is rare it is mostly fatal and require aggressive and prompt treatment is mandatory from saving the patient from death

REFERENCES:
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