Cerebra Odollam Quiz

Cerebra Odollam (Cardiac Poison)

• Botanical Name: Cerebra odollam
• Family: Apocynaceace
• English Names: Suicide tree, Buddha tree, Sea Mango, pong-pong, othalanga
• Native Region: South India, Madagascar, Southeast Asia
• Toxic Part: Kernel (core of the fruit)
• Toxic Chemical Constituents:
  • Cerberin
  • Cerberoside
  • Nerifolin
• Mode of Action:
  • Cerberin inhibits Na+, K+ ATPase in cardiac myocytes (similar to digoxin)
• Signs & Symptoms:
  • Bitter taste
  • Nausea
  • Vomiting
  • Chest pain
  • Palpitations
  • Bradycardia
  • Syncope
  • Hyperkalemia
  • Thrombocytopenia
  • ECG abnormalities
  • Death due to heart attack
• Fatal Dose: Kernel of one fruit
• Fatal Period: 12-24 hours
• Treatment:
  • Supportive therapy for bradycardia and hyperkalemia
  • Atropine followed by temporary cardiac pacing
  • Administration of digoxin immune Fab
  • Extracorporeal membrane oxygenation
• Postmortem Examination:
  • Non-specific changes
  • Signs of GIT irritation may be seen
  • Stomach and duodenum may be congested with seed fragments
  • Visceral organ congestion
• Medico-legal Aspects:
  • Used for suicide and homicide
  • Common suicidal agent in Kerala (more common in females)
  • Can be used for homicide by adding kernel to toddy, liquor, or food to disguise taste
  • Accidental poisoning can occur by mistakenly eating the fruit

Digitalis (Cardiac Poison)

• Botanical Name: Digitalis purpurea
• Family: Scrophulariaceae
• Vernacular Names:
  • Hindi: Tilpushpi
  • English: Foxglove, Common Foxglove, Purple Foxglove
• Synonyms: Hritpatri
• Toxic Part: Roots, seeds, and leaves

Toxic Chemical Constituent (Active Principle)

• Entire plant is toxic, containing over thirty cardiac and steroidal glycosides.
• The roots, leaves, and seeds contain:
  • Digitoxin
  • Digitalin
  • Digitalein
  • Digitonin

Ras Panchaka

• Ras: Tikt
• Guna: Laghu, Ruksh
• Virye: Sheeta
• Vipaka: Katu

Mode of Action

• Glycosides act directly on the heart muscle (prolong diastolic period) and improve the function of the failing heart.
• In toxic doses, excitability is increased with extrasystoles (premature ventricular contractions).

Sign and Symptoms

• Gastrointestinal (GIT): Anorexia, nausea, vomiting, diarrhea

• Cardiac: Arrhythmias, including extrasystoles, ventricular tachycardia and fibrillation, SA block, AV block

• Endocrine: Gynecomastia

• Visual: Transient amblyopia (lazy eye), photophobia, diplopia, blurring, scotomata, halos

• Skin: Urticaria

• Central Nervous System (CNS): Headache, fatigue, muscle weakness, neuro-psychiatric disorders, confusion, anxiety, depression, disorientation, drowsiness, delirium, hallucinations, trigeminal neuralgia

• Death: Cardiovascular collapse

Fatal Dose and Fatal Period

Treatment

• ECG monitoring is necessary to guide treatment.
• Gastric lavage with a solution of tannic acid.
• Activated charcoal administration.
• Purgatives may be given.
• Atropine (0.6 mg IV) to treat bradycardia.
• Potassium chloride to reduce extrasystoles.
• Specific antidote for cardiac arrhythmias: lignocaine (100 mg IV), novocaine or propranolol.
• Trisodium EDTA may help lower serum calcium.
• Symptomatic treatment.