[A Potentially Fatal Aphrodisiac: Cantharidin Poisoning]. / Um Afrodisíaco Potencialmente Fatal: Intoxicação por Cantaridina.

Cantharidin is a toxin extracted from coleoptera beetles, commonly known as 'Spanish fly'. Traditionally it was used as an aphrodisiac, a vesicant or as an abortifacient. Intoxication by this substance has been widely reported, generally associated with gastrointestinal complications, such as digestive hemorrhage, and genitourinary disorders, such as hematuria and acute kidney injury. The authors describe the case of a 51-year old male patient who developed severe cantharidin poisoning after ingesting a preparation ('tea formulation') containing the substance. The patient reported a burning sensation in his oral cavity, diarrhea and hematuria, having sustained acute kidney injury and atypical neurological symptoms. Due to the lack of an antidote, the available treatment options are reduced to supportive measures. This case strengthens the need for a thorough medical history to ascertain the use of 'natural' products and medicinal herbs (i.e. of unregulated origin), and the importance of educating the community to their potential toxicity.

A cantaridina é uma toxina extraída de coleópteros, comummente conhecidos como 'Spanish fly'. Historicamente utilizada como afrodisíaco, vesicante e abortivo. A intoxicação por este agente encontra-se amplamente descrita, tipicamente com envolvimento das mucosas gastrointestinal, com hemorragia digestiva, e genitourinária, com hematúria e lesão renal aguda. Os autores apresentam o caso de um doente do sexo masculino, com 51 anos que desenvolveu um quadro de intoxicação aguda por cantaridina, após ingestão de uma preparação ('chá') desta substância, com ardor na cavidade oral, diarreia, disúria, hematúria, lesão renal aguda e com um quadro neurológico atípico. A toxicidade pela cantaridina é sistémica, contudo, o envolvimento neurológico é raro. Dada ausência de um antídoto, preconiza-se a terapêutica de suporte. Este caso reforça a importância de uma anamnese detalhada, incluindo a utilização de produtos 'naturais' ou de ervanária (i.e. de origem não controlada), e da necessidade de alertar os doentes para a sua potencial toxicidade.

Severe camphor poisoning, a seven-year observational study.

In a retrospective case series from 2007 to 2014, we searched for any accidental/intentional, and recreational cases of pure camphor poisoning through hospital records. Epidemiological data, as well as factors correlated with seizure, were evaluated. Thirty cases including 29 males were recruited with a median age of 18 years (range; 0.2-87). Patient's reported ingestion rate of camphor was 1.5-15 grams. Almost all of the patients (96.7%) were conscious on arrival time and the ingestion to the presentation time ratio was 7±5h. It was observed that in a majority of the cases (53.4%), decreasing libido was the main intent of Camphor ingestion. Nausea and vomiting occurred in 22 (73.3%) cases and tonic-clonic seizure was seen in 12 (40%) patients. Mean presentation time was significantly longer in patients who experienced seizure (9.1±6.1h vs. 5.2±2.8h, p=0.05). No correlation was found between the amount of ingested camphor (grams or mg/kg) and vital signs along with the bio-chemistry results. Not only did all of our cases survive but also they exclusively received supportive care.

[Methemoglobinemia as a result of acute accidental "poppres" poisoning ­ a case report].

Recently we observe an increase in the number of intoxications due to xenobiotics that may induce acute methemoglobinemia. Our study showed a case of acute methemoglobinemia (MetHb 55..2%) in 25 ­ year old man. Clinical symptoms were caused by ingestion of "poppers" which was used by patient as "aphrodisiac". Summary: Conclusions: 1. Oral intake of alkyl nitrites, including isobutyl nitrite, is burdened with the risk of life-threatening methemoglobinemia . 2. In the case of poisonings running with normal pO2, reduced level of oxygen saturation, clinical signs of cyanosis does not react to oxygen therapy, and "chocolate" tinge of blood methemoglobinemia should be suspected. 3. In every case of MetHb the use of antidote, which is methylene blue, should be considered. 4. The severity of cyanosis correlates with the level of methemoglobin.

An interesting case of cardiotoxicity due to bufotoxin (toad toxin).

Consumption of toads for their aphrodisiac effect is a common practice in Laos, China and in some parts of India. Toad secretions from parotid and skin contains toxin similar to cardiac glycosides. It results in bradycardia and cardiac dysfunction leading on to death in some cases. We report a case of toad poisoning in a young previously healthy male.

Toad venom poisoning: resemblance to digoxin toxicity and therapeutic implications.

A healthy man developed gastrointestinal symptoms after ingesting purported aphrodisiac pills. He had severe unrelenting bradycardia, hyperkalaemia, and acidosis. He rapidly developed severe life threatening cardiac arrhythmias and died after a few hours. He was found to have positive serum digoxin concentrations, although he was not taking digoxin. Toad venom poisoning is similar to digitalis toxicity and carries a high mortality. Cardiac glycoside poisoning can occur from ingestion of various plants and animal toxins, and the venom gland of cane toad (Bufo marinus) contains large quantities of cardiac glycosides. Toad venom, a constituent of an aphrodisiac, was considered responsible for the development of clinical manifestations and death in this patient. Digoxin specific Fab fragment has been reported to be beneficial in the treatment of toad venom poisoning. This report alerts physicians to the need to be aware of a new community toxic exposure, as prompt treatment with digoxin specific Fab fragment may be life saving. The treatment approach to patients with suspected toad venom poisoning is described.

Efficacy of digoxin specific Fab fragments (Digibind) in the treatment of toad venom poisoning.

Chan Su, a traditional Chinese medication, and Love Stone, a topical aphrodisiac, are both made from dried venom of the toad bufo bufo gargarizans and contain bufalin, cinobufotalin, cinobufagin, and other cardioactive steroids of the bufadienolide class. Deaths have occurred following ingestion of these products and the clinical course resembles digoxin toxicity. The purpose of this study was to determine the efficacy of digoxin specific Fab fragments in treating Chan Su poisoning. An ethanolic extract was prepared from Chan Su. Digoxin specific Fab fragments were reconstituted in normal saline to a concentration of 80 mg/ml. An approximate LD90 dose was determined in preliminary experiments. Mice were then randomly divided into a treatment group of 15 mice and a control group of 30 mice. The treatment group was pretreated with 20 ml/kg of digoxin specific Fab fragment solution by intraperitoneal injection at t = 0, followed by 10 ml/kg of digoxin specific Fab fragments intraperitoneal at t = 30 min. The control group was pretreated with equal volumes of intraperitoneal normal saline at the same times. Immediately following the 30 min injection, both groups were given the estimated LD90 dose of Chan Su extract by subcutaneous injection. An endpoint of survival at 6 h was chosen after preliminary results showed that all deaths occurred in the first 4 h. All 30 of the control mice had seizures followed by death compared to 11 seizures and 7deaths in the 15 treatment mice. These results were statistically significant by Fisher's exact test (p = 0.00003 for mortality and p = 0.009 for seizures). Digoxin specific Fab fragments are effective in the treatment of Chan Su poisoning in mice and may be effective for poisoning by other cardioactive steroids of the bufadienolide class.

[Amyl nitrite poisoning]. / Amylnitritforgiftning.

Two cases of amylnitrite poisoning are presented. In both cases, severe methaemoglobinemia developed after ingestion of approximately 10 ml of amylnitrite. When admitted to hospital, both patients were deeply cyanosed, and arterial blood samples were noticed to be chocolate brown. They were intravenously treated with methylene blue. Within one hour the condition of both patients had improved dramatically, and blood gas-samples had normalised. In cases of cyanosis with no obvious genesis, poisoning with amylnitrite should be considered.

[Poisoning with "poppers", a rare cause of methemoglobinemia observed in emergency cases]. / L'intoxication au "poppers", cause rare de méthémoglobinémie observée aux urgences.

BACKGROUND: Methemoglobulinemia should be entertained as a differential diagnosis in patients with cyanosis. Recently in France there has been an increase in the number of cases of acquired methemoglobulinemia due to inhalation of poppers. CASE REPORTS: Four patients were admitted to the emergency room of a Paris hospital in a state of unconsciousness with cyanosis. All four patients had inhaled poppers shortly before admission. The clinical course was rapidly favorable after intravenous infusion of methylene blue in 3 cases. DISCUSSION: Poppers are inorganic aliphatic nitrites used for their relaxing effect on smooth muscle and for their aphrodisiac effect. One poorly recognized effect is the development of methemoglobulinemia. Tissue hypoxia results because methemoglobulin cannot bind oxygen, leading to a brown or blue coloration of the blood. Methemoglobulin usually results from exposure to a wide variety of oxidizing compounds including certain drugs. Methylene blue is the specific treatment for symptomatic methemoglobulinemia. These four cases emphasize the toxic effect of products sold in sex shops and calls attention to the life-threatening risks involved.

Saturday night blue--a case of near fatal poisoning from the abuse of amyl nitrite.

A case of severe methaemoglobinaemia caused by the abuse of volatile nitrites is reported. The agents are commonly abused, but this complication is rare. The clinical presentation can make diagnosis difficult; however, the subsequent treatment needs to be rapid to avoid serious morbidity or mortality. This report presents the clinical picture and the background information leading to the detection and treatment of this unusual problem.

GC/MS comparison of the West Indian aphrodisiac "Love Stone" to the Chinese medication "chan su": bufotenine and related bufadienolides.

The death of a 23-year-old man resulting from digoxin-like toxicity and heart failure was attributed to ingestion of a West Indian aphrodisiac known as "Love Stone." GC/MS analyses identified bufotenine, a controlled substance under both US and New York State statutes. In addition, a series of bufadienolides, namely resibufogenin, bufalin, and cinobufagin, were also identified. Bufadienolides, which are derived from toad venom or secretions, are cardiotonic steroids that cause symptoms similar to digoxin. GC/MS analyses of the Chinese medication "Chan Su," a product derived from toads, produced a highly similar elution profile and contained the same compounds as "Love Stone." The data demonstrate that the aphrodisiac was also derived from toads.

Treatment of toad venom poisoning with digoxin-specific Fab fragments.

Toxicity from toad venom poisoning is similar to digoxin toxicity and carries a high mortality rate. We report on six previously healthy men who developed vomiting and bradycardia after ingesting a purported topical aphrodisiac. Each patient had positive apparent digoxin levels and the first four patients died of cardiac dysrhythmias. The last two patients recovered following treatment with digoxin Fab fragments. We analyzed samples of the purported aphrodisiac and found that it was identical to Chan Su, a Chinese medication made from toad venom. To our knowledge, this is the first reported use of digoxin Fab fragments to treat toad venom poisoning.

Deaths associated with a purported aphrodisiac--New York City, February 1993-May 1995.

During February 1993-May 1995, the New York City Poison Control Center (NYCPCC) was informed about onset of illness in five previously healthy men after they ingested a substance marketed as a topical aphrodisiac; four of the men died. These cases were investigated by the New York City Department of Health, the New York City Department of Environmental Protection, and the Food and Drug Administration (FDA). Four cases were referred to the NYCPCC and one case to the New York City medical examiner's office. The decedents died from cardiac dysrhythmias, and all five patients had measurable levels of digoxin* detected in their serum. Digoxin had not been prescribed for therapeutic purposes for any of these patients, and none had medical conditions associated with endogenous digoxin-like immunoreactive substances. The purported aphrodisiac contains bufadienolides, naturally occurring cardioactive steroids that have digoxin-like effects. This report describes three of the five case reports, summarizes the investigations of the five cases, and underscores the health risks associated with inappropriate use of preparations containing digoxin-like substances.

[Acute poisoning caused by cantharidin ingestion for aphrodisiac purposes. A clinical case]. / Intossicazione acuta per ingestione di cantaridina a scopo afrodisiaco. Caso clinico.

We report a case of a man who died after ingestion of cantharidin as aphrodisiac. After evaluating the toxicology, we examined the development and therapeutic possibilities of handling the poisoning including charcoal hemoperfusion.

A fatal case of poisoning with cantharidin.

A case of fatal poisoning due to voluntary ingestion of cantharides powder for aphrodisiac purposes is reported. Clinical history, autopsy and analytical findings are described. Blood and urine samples collected during the 30 h of survival, as well as the cantharides product, were analyzed by gas chromatography-mass spectrometry. On the basis of the percentage of the active principle measured in the powder, an ingested dose of 26-45 mg of cantharidin could be estimated.

Methaemoglobinaemia after ingestion of amyl nitrite.

We report a case of methaemoglobinaemia in a 2 year old girl after ingestion of an 'aphrodisiac' containing nitrite. The availability of these products, their poor labelling, and their intended presence in domestic bedrooms all serve to increase the hazard they pose to young children.