A Case of Strychnine Poisoning from a Southeast Asian Herbal Remedy.

BACKGROUND: Strychnine is a highly toxic alkaloid found in both naturally occurring compounds and commercial products. Extracts of fruits from the strychnine plant have been used in Southeast Asia as remedies for various illnesses. We describe strychnine poisoning from ingestion of a Southeast Asian herbal supplement quantitatively confirmed by serum and urine analysis. CASE REPORT: A 40-year-old Cambodian woman presented to the emergency department with a complaint of jaw pain and spasms. The patient was staying with a relative and drank 2 oz from an unmarked bottle that she thought contained vodka. She then developed trismus and abdominal cramping, after which a family member said the bottle contained a compound called "slang nut." Her vital signs were as follows: heart rate 102 beats/min, blood pressure 142/72 mm Hg, respiratory rate 20 breaths/min, and oxygen level 100%. The physical examination revealed no significant abnormalities. Serum toxicologic screens were negative except for strychnine levels that revealed a serum concentration of 350 ng/mL and a urine concentration >200 ng/mL. The patient was observed for 2.5 h and discharged with no long-term complications. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Strychnine is a well-known compound that has been used in poisons, rodenticides, and performance enhancing drugs for years. In the Western world, strychnine is a much less common poisoning given that its use has been restricted because of the potential for severe toxicity; however, given its potentially high mortality, it is important to be aware of other sources of exposure, including those from herbal and homeopathic remedies.

Seizures caused by ingestion of Atropa belladonna in a homeopathic medicine in a previously well infant: case report and review of the literature.

Atropa belladonna is a poisonous plant that can cause anticholinergic effects when ingested. Roots, leaves, and fruits of the plant contain the alkaloids atropine, hyoscyamine, and scopolamine, which can lead to an anticholinergic toxidrome; however, not all characteristics of the toxidrome are necessarily present in each case of poisoning. We present an infant who suffered serious seizures after ingestion of a homeopathic agent containing A. belladonna. The 20-day-old infant arrived at the emergency department with fever and generalized seizures for 30 minutes, 2 hours after ingesting the correct dose of a homeopathic medication agent used for infantile colic. The patient was treated with intravenous benzodiazepines and antibiotics after a full sepsis work up; all the laboratory results were normal and the fever resolved after several hours. The infant recovered fully with normal neurological function and a normal electroencephalogram. This infant probably manifested what is known as the central anticholinergic syndrome. We discuss his presentation and review of the literature on this topic.

Complementary and alternative medicine in children: an analysis of the recent literature.

PURPOSE OF REVIEW: Although many publications have documented the use of complementary and alternative medicine (CAM) in children and adolescents, most have lacked the scientific rigor to establish clear benefits over so-called conventional medicine. We reviewed the literature published in the past year to identify the types of CAM most often studied in children, the variety of conditions to which these modalities are applied, and the methodologies used in the articles exploring the most prevalent CAM modalities. RECENT FINDINGS: We identified 111 published articles on CAM use in children in 2011. The most common modalities were herbal/dietary supplements, acupuncture, massage, chiropractic, and homeopathy. The most commonly studied conditions were pain, headache, attention deficit hyperactivity disorder (ADHD), asthma, and colic. Although a majority of the articles consisted of reviews, case reports, and other nonhypothesis-driven methodologies, we did find that several were randomized controlled trials, meta-analyses, or systematic reviews. These methodologies, however, rarely accounted for the majority of publications on a particular therapy or condition. SUMMARY: The use of CAM in children continues to occupy a niche area of interest for many providers and families, but only a minority of articles published in the past year utilized methods of sufficient rigor to provide a useful comparison to more conventional therapies.

Effectiveness of a homeopathic complex medicine in infantile colic: A randomized multicenter study.

OBJECTIVES: Infantile colic is a common benign disease occurring in early infancy that may have a great impact on family life. In the present study, the effectiveness and safety of the complex homeopathic medicine Enterokind was compared with Simethicone for treating infantile colic. DESIGN AND SETTING: Current data were drawn from a prospective, multicenter, randomized, open-label, controlled clinical trial that was conducted in 2009 in 3 Russian outpatient clinics. Children received either Enterokind (Chamomilla D6, Cina D6, Colocynthis D6, Lac defloratum D6 and Magnesium chloratum D6) or Simethicone. Data from infants ≤ 6 months with infantile colic are presented here. MAIN OUTCOME MEASURES: The main outcomes assessments were the change of total complaints score (maximum 17 points) and total objective symptoms score (maximum 22 points) after 10 days of treatment. RESULTS: Data from 125 infants ≤ 6 months with infantile colic were analyzed. The differences in total complaints and objective symptoms scores between baseline and day 10, estimated from the ANCOVA model, were found to be highly significant (p < 0.0001; ITT) in favor of Enterokind, both for complaints (Δ=-2.38; 95% confidence interval (CI): [-2.87; -1.89]) and for objective symptoms (Δ=-2.07; 95% CI: [-2.65; -1.49]). 1 adverse event (AE), vomiting, occurred under Enterokind and was rated to be unlikely related to it; 4 AEs occurred under Simethicone. All AEs were non-serious. CONCLUSIONS: The current study indicates that Enterokind is an effective and safe homeopathic treatment for functional intestinal colic in infants ≤ 6 months.

Lethal Lullabies: A History of Opium Use in Infants.

Poppy extract accompanied the human infant for more than 3 millenia. Motives for its use included excessive crying, suspected pain, and diarrhea. In antiquity, infantile sleeplessness was regarded as a disease. When treatment with opium was recommended by Galen, Rhazes, and Avicenna, baby sedation made its way into early medical treatises and pediatric instructions. Dabbing maternal nipples with bitter substances and drugging the infant with opium were used to hasten weaning. A freerider of gum lancing, opiates joined the treatment of difficult teething in the 17th century. Foundling hospitals and wet-nurses used them extensively. With industrialization, private use was rampant among the working class. In German-speaking countries, poppy extracts were administered in soups and pacifiers. In English-speaking countries, proprietary drugs containing opium were marketed under names such as soothers, nostrums, anodynes, cordials, preservatives, and specifics and sold at the doorstep or in grocery stores. Opium's toxicity for infants was common knowledge; thousands of cases of lethal intoxication had been reported from antiquity. What is remarkable is that the willingness to use it in infants persisted and that physicians continued to prescribe it for babies. Unregulated trade, and even that protected by governments, led to greatly increased private use of opiates during the 19th century. Intoxication became a significant factor in infant mortality. As late as 1912, the International Hague Convention forced governments to implement legislation that effectively curtailed access to opium and broke the dangerous habit of sedating infants.

Diez años de actuación homeopática en cólicos nefríticos y litiasis renal en Pinar del Río / Ten years of homeopathic operations in renal colic and nephrolithiasis in Pinar del Rio

Introducción: la homeopatía, no escapa a la medicación que puede emplearse en la litiasis renal y sus síntomas dolorosos. Objetivo: incorporar la medicación homeopática al tratamiento sintomático de la litiasis renal. Métodos: se realizó estudio descriptivo, prospectivo y longitudinal en pacientes con diagnóstico de litiasis renal o cólicos nefríticos valorados en la consulta de Medicina Natural y Tradicional, procedentes del Servicio de Urgencia u hospitalizados en el hospital "León Cuervo Rubio" de Pinar del Río, desde enero de 2004 a diciembre de 2014. Se empleó el valor absoluto y porcentual. Resultados: fueron tratados 248 pacientes, obteniéndose el 73 % (181 pacientes) atendidos por cólicos renales y 67 pacientes por litiasis renal, predominó el lado derecho. La combinación homeopática de (Lycopodium 6 CH y Berberis 6 CH fue satisfactoria para el alivio del dolor en 153 pacientes (84,53 %). Se eliminaron los cálculos a 44 pacientes con litiasis renal. De los pacientes que presentaban cálculos de más de un centímetro (65,67 %) disminuyeron de tamaño. Conclusiones: la combinación homeopática utilizada resultó ser eficaz en el tratamiento del cólico nefrítico y la litiasis renal.

Introduction: Homeopathy does notevade being amedication that can be used in the renal nephrolithiasis and its painful symptoms. Objective: To incorporate homeopathic medication to the symptomatic treatment of nephrolithiasis. Methods: A descriptive, longitudinal, prospective studywas carried out,in patients with diagnosis of nephrolithiasisor renal colic, evaluated at the Natural and Traditional Medicine service, coming from the Emergency Room or admitted at the hospital Leon Cuervo Rubioin Pinar del Rio, from January 2004 to December 2014. Absolute values and percentages were determined. Results: 248 patients were treated, obtaining the following main results. 73 % (181 patients) assisted due to renal colics and 67 patients for nephrolithiasis. Prevalence was found on the right side. The homeopathic combination of Lycopodium 6 CH and Berberis 6 CH was satisfactory for the relief of the pain in 153 patients (84.53 %). 44 patients with nephrolithiasiseliminated the stones. The patients who presented lithiasis bigger than a centimeter (65.67 %), diminished its size. Conclusions: The homeopathic combination used seems to be effective in the treatment of the renal colic and nephrolithiasis.

Use of a homeopathic preparation for "infantile colic" and an apparent life-threatening event.

OBJECTIVE: An apparent life-threatening event (ALTE) caused by ingestion of drugs or toxins has been reported rarely among infants. None of these agents was homeopathic medication. We report 11 infants who presented with an ALTE after ingestion of Gali-col Baby, a homeopathic agent indicated for "infantile colic." METHODS: A retrospective case-control study was conducted. Charts of all infants who were younger than 1 year and were admitted with an ALTE from January 2005 through August 2008 to the pediatric division at the Barzilai Medical Center were reviewed. Age-matched infants who were admitted on the same dates for a reason other than ALTE served as a control group. Information on medications administered before admission was recorded. RESULTS: During the study period, 36 635 children visited the pediatric emergency department of the Barzilai Medical Center. There were 11 057 admissions to the pediatric division during this period, 115 of which were because of an ALTE. Eleven of these infants received Gali-col Baby before the event as opposed to none in the control group (P < .005). Three infants received a significant overdose, compared with the manufacturer's recommended dosage. After a thorough investigation, no other presumptive causes for ALTE were found among the 11 infants. CONCLUSIONS: Gali-col Baby is associated with an ALTE in some infants. There are no published controlled trials on the efficacy or safety of its use; therefore, better control and supervision of Gali-col Baby and probably other homeopathic medications are needed to prevent possible serious adverse effects.

The use of homeopathic products in childhood: data generated over 8.5 years from the Avon Longitudinal Study of Parents and Children (ALSPAC).

BACKGROUND: Very little is known about the use of homeopathic products (HP) in children. The Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based cohort in the South-West of England, has collected homeopathic data through self-completion questionnaires posted to the mother at regular time points throughout childhood. The aim of this article is to describe the use of these products in a large cohort of children from birth to 8.5 years of age. METHODS: Questions asked about the use of HP within a preceding time period at seven time points from birth to 8.5 years of age. Additional questions at 18 and 81 months asked about the conditions treated and at 81 months who had prescribed the HP. RESULTS: Eleven and eight-tenths percent (11.8%) of this cohort used a HP at least once up to 8.5 years of age. Chamomilla for teething and Arnica for soft-tissue bruising were the most commonly used products. The most frequently prescribed products were for common self-limiting infantile conditions such as colic, cuts and bruises, and teething. Parents were most likely at 81 months to prescribe HP for their children (46.3% of all prescription sources) and 10% of products were prescribed by general practitioners. Confusion about what constituted a HP was present in nearly 10% of answers. CONCLUSIONS: No other study, to our knowledge, has been able to map the use of HP over such a long time period in such a large cohort of children. The amount of HP use reflects a significant minority of the population who use complementary and alternative medicine treatments to manage the health of their family. Health care professionals should be aware of the confusion surrounding HP and have knowledge around some of the more commonly used HP. Parents and carers are using homeopathy wisely with appropriate remedies consistently used for acute problems. Research could focus on greater information delivery to the community and monitoring of potential health and cost benefits, or side-effects of the use of HP for acute and chronic conditions in children.

Effects of Spascupreel versus hyoscine butylbromide for gastrointestinal cramps in children.

BACKGROUND: Gastrointestinal spasms and cramps are common in children as well as in adults. Alternative medical practices such as chiropractice and homeopathy are becoming increasingly popular in Europe and the USA. The effectiveness and tolerability of the homeopathic preparation Spascupreel was compared with that of hyoscine butylbromide treatment in children <12 years of age. METHODS: An observational cohort study in 204 children <12 years was conducted over a 1 week treatment period. The efficacy of the respective therapies were evaluated on the effect on severity of spasms and clinical symptoms (pain/cramps, sleep disturbances, distress, eating or drinking difficulties and frequent crying). Compliance was evaluated on a four-point scale from 'very good' to 'low'. Evaluation was done by the practitioner based on information given by the patient or minder. RESULTS: The analysis showed comparative improvements with the homeopathic preparation and hyoscine butylbromide therapy on severity of spasms, pain/cramps, sleep disturbances, eating or drinking difficulties, and frequent crying, all as evaluated by the practitioner. Both treatments were very well tolerated. CONCLUSIONS: For patients opting for a homeopathic therapy, Spascupreel seems to be an effective and well tolerated alternative to conventional therapies in children suffering from gastrointestinal spasms.

O uso dos medicamentos homeopáticos no controle e tratamento da cólica do lactente

Este trabalho apresenta uma revisão de literatura sobre o controle e tratamento das cólicas dos recém-nascidos com a prescrição de medicamentos homeopáticos, seus critérios de escolha e seus efeitos. (AU)

This paper presents a literature review on the control and treatment of colic in newborns with the prescription of homeopathic medicines, its selection criteria and their effects. (AU)

Homeopatia para o tratamento de transtornos gastrintestinais em crianças / Homeopathy for the treatment of gastrointestinal disorders in children

Background: Colic and diarrhea are among the most common gastrointestinal disorders in childhood, which manifest spontaneously and acute. The allopathic treatment consists, in most cases, in the administration of the association homatropine-dimethicone to relieve colic, and oral rehydration and loperamide in cases of diarrhea [1,2]. The ineffectiveness of the conventional treatment and the possible adverse effects they may cause have led to increase the demand from children? parents for complementary and alternative therapies, and homeopathy can be one of the first choices in this disorders [3]. Aims: make a literature review evaluating the effectiveness of homeopathic treatment for colic and diarrhea in children, observing the relation between the main medicines prescribed in these disorders and their pathogenesis described in materia medica. Methodology: a literature research was performed applying electronic database, including Medline, HomeoIndex, BIREME, LILACS, PubMed, SciELO, and ScienceDirect in the period from September to December 2010. Results: Data found indicate that few studies are available in the literature to prove the effectiveness of homeopathic medicines for colic and diarrhea in children, but the applicability of this therapeutic modality seems to be useful, safe and low cost, which are important factors for less favored communities. Besides, studies concerning diarrhea are more frequent, not only because of its gravity, but also for the duration, which makes more adequate the monitoring, on the contrary to acute colic. The most cited medicines were Chamomilla, Nux vomica, Arsenicum album and Mercurius solubilis. Conclusions: Homeopathy can be an important source of colic and diarrhea relief. However, more investigations should be performed in order to show parents how valuable this kind of therapy can be to children and the whole family.(AU)

Introdução: a cólica e a diarreia estão entre os transtornos gastrintestinais mais comuns da infância, os quais se manifestam de forma espontânea e aguda. O tratamento alopático consiste, na maioria dos casos, na administração da associação homatropina-dimeticona para o alívio da cólica, e, reidratação oral e loperamida nos casos de diarreia [1,2]. A falta de eficácia do tratamento convencional e os possíveis efeitos adversos que o mesmo pode causar têm levado ao aumento da demanda por parte dos pais por terapias alternativas e complementares e a homeopatia pode ser uma das primeiras escolhas nestas situações [3]. Objetivos: fazer uma revisão da literatura avaliando a efetividade do tratamento homeopático para cólica e diarreia em crianças, observando a relação entre os principais medicamentos prescritos nestes casos e suas patogenesias descritas na matéria médica. Metodologia: foi realizada uma pesquisa na literatura usando as bases de dados eletrônicas, incluindo Medline, Homeoindex, BIREME, Lilacs, Pubmed, Scielo e Sciencedirect, no período de setembro a dezembro de 2010. Resultados: os dados encontrados indicam que poucos estudos estão disponíveis na literatura para provar a efetividade dos medicamentos homeopáticos em cólica e diarreia em crianças, mas a aplicabilidade desta modalidade terapêutica parece ser útil, segura e de baixo custo, que são fatores importantes para comunidades de baixa renda. Além disso, os estudos em relação a diarreia são mais frequentes, não apenas por sua gravidade, mas também pela duração, que torna mais adequado o monitoramento, ao contrário da cólica que é aguda. Os medicamentos mais citados foram Chamomilla, Nux vomica, Arsenicum album e Mercurius solubilis. Conclusões: a homeopatia pode ser um importante recurso para o alívio da cólica e da diarreia. Entretanto, mais pesquisas devem ser realizadas a fim de mostrar aos pais quão valiosa este tipo de terapia pode ser para as crianças e toda a família.(AU)

Tratamento homeopático no choro infantil

Revisão de literatura sobre choro infantil. Enfoque nas causas de choro fisiológicas: cólicas, insônia e dentição. Abordagem da etiologia, complicações e tratamento. Avaliação do tratamento medicamentoso tradicional e homeopático, e não medicamentoso, comportamental. (AU)

Infant crying review. Focus on physiological crying causes: infantile colic, insomnia and dentition. Etiology, complications and treatment approaches. Conventional and Homeopathic medication treatments and behavioral treatment. (AU)

Colico renoureteral / Renouretenal colic

El proposito de este trabajo es recordar los sintomas y los medicamentos usados mas frecuentemente en el dolor agudo producido por el colico renal y la materia medica comparada de los arriba mencionados. (AU)

Syndromes douloureux, hemorragiques et psychologiques de la fin de la grossesse / Painful, hemorrhagic and psychological syndrome of the end of pregnancy

Si certains problemes de fin de grossesse exigent une intervention urgente et parfois dramatique, la plupart d'entre eux, s'ils sont pris a temps, peuvent se resoudre de facon elegante, efficace et... (AU)

Colites et côlons irritables en pédiatrie / Colitis and irritables colons in pediatrics

Dans la pratique pédiatrique courante les pathologies colitiques fonctionnelles sont très fréquentes et revêtent des aspects cliniques très variables et différents suivant les tranches d'âges considérées. L'auteur procède à un rappel... (AU)