Hawthorne root (Crataegus mexicana) toxicity.

Here we present the case of a patient who purchased a Hawthorne root (Crataegus mexicana) product, Raiz de Tejocote, for weight loss purposes. She presented with diffuse myalgias, dizziness and a heart rate of 52 beats per minute. At triage and at initial evaluation, the patient denied taking any medications, but on iterative questioning concerning over-the-counter, over-the-internet and herbal medications, she reported taking Hawthorne root tablets in the three days prior to the emergency department (ED) visit for the purpose of weight loss. The product was purchashed through the internet. Her plasma digoxin concentration was 0.4 ng/ml the patient's constellation of symptoms, as well as the detectable plasma digoxin concentration, were consistent with hawthorne root toxicity. Hawthorne root has intrinsic cardiac glycoside activity. In addition, Hawthorne root may cause a range of toxicity. Mild symptoms can include flu-like syndrome with significant myalgias. However, in the more severe exposures the cardiac glycoside effects can result in bradycardia and hemodynamic instability. Symptoms resolved with ED observation. The heart rate normalized. This case reinforces the importance of asking a patient about all medications, including over-the-counter, over-the-internet and herbal medications.

The Dangers of Unregulated Weight Loss Supplements: Tejocote-Induced Acute Liver Injury.

Tejocote, a product of the hawthorn tree and a common staple of Hispanic culinary practices and traditional medicine, has recently gained traction in the United States and Mexico as a means to achieve rapid effortless weight loss. This herbal supplement has largely evaded regulation by governing bodies in both countries despite documentation of several potentially serious adverse effects associated with its use. The present report describes the case of a middle-aged Hispanic female who ingested Tejocote with famotidine and presented with acute gastrointestinal symptoms and transaminitis, an unexpected symptom that warrants further investigation.

Tejocote Root's Role in Symptomatic Mobitz Type 1 Heart Block: A Compelling Case Report.

The clinical presentation and diagnosis of Tejocote root toxicity causing Mobitz Type 1 remains a scarcely clinical phenomenon, often resulting in delayed diagnosis and treatment. This case report highlights a 30-year-old female presenting with a constellation of symptoms, including fatigue, dizziness, chest pressure, myalgias, nausea, vomiting, and peripheral tingling. Significantly, the patient had been using Tejocote root as an over-the-counter laxative acquired from Mexico. Laboratory findings revealed detectable Digoxin levels in her bloodstream, while an electrocardiogram (EKG) indicated sinus bradycardia with Mobitz Type 1 heart block. The patient was treated with a single dose of atropine 0.5 mg IV push. A repeat EKG before discharge showed resolution of the Mobitz type 1. This case underscores the potential cardiovascular repercussions of Tejocote root consumption and emphasizes the importance of heightened clinical awareness, especially in regions where such herbal supplement usage is prevalent.

An Atypical Etiology of Acute Pericarditis: A Case Report.

Acute pericarditis is caused by inflammation of the pericardial sac and is characterized by sharp and pleuritic chest pain, which is accompanied by a pericardial friction rub and serial electrocardiogram (ECG) changes. Although there are many known etiologies of pericarditis, we present the first known case of a herbal supplement, the Tejocote root, causing acute pericarditis in a previously healthy 23-year-old female. Her ECG showed t-wave inversions that resolved with colchicine and non-steroidal anti-inflammatory drug therapy. Prior studies have demonstrated that it can cause adverse cardiovascular effects, but this is the first documented case of the Tejocote root causing acute pericarditis. This case report reinforces the importance of inquiring about supplements patients may be taking, especially when looking for the etiology of pericarditis.

Multi-Criteria Analysis for the Prioritization of Areas for the In Situ Conservation of Crataegus L., an Underutilized Fruit Tree in Mexico.

Complementary ex situ and in situ conservation, including the on-farm alternative, is a highly desired and dynamic strategy that allows the natural evolution of the conserved germplasm. Due to the high costs involved, in addition to the limitations of both economic and human resources, in situ conservation must focus on areas where the greatest benefits are obtained, and the efforts made result in better impacts. Therefore, using spatial multi-criteria analysis and expert knowledge, 22 and 23 criteria were obtained as important for the conservation of wild and cultivated hawthorn, respectively. Criteria weights were calculated by the analytic hierarchy process and expert knowledge. The results showed species richness, phenotypic and ecogeographic diversity, and areas not covered by the official protected areas network were the most important criteria for in situ conservation of wild hawthorn. Prioritized areas were particularly focused in Chiapas, State of Mexico and Morelos. The prioritized areas for the in situ conservation of cultivated hawthorn were mostly defined by criteria such as number of cultivated varieties, number of uses, phenotypic diversity, ecogeographical diversity, and areas with rainfed agriculture. These areas were located mainly in Puebla. From this study, we propose a list of priority areas for the in situ conservation of both cultivated and wild hawthorn.

Authentication of tejocote (Crataegus mexicana) dietary supplements based on DNA barcoding and chemical profiling.

Tejocote (Crataegus mexicana, Mexican hawthorn), known as a weight-loss supplement, has been marketed online and is easily available for overseas direct purchase. Alipotec (brand name) is known as one of the most popular products containing tejocote in Mexico and other countries. However, adverse effects have been reported by users of these supplements. Therefore it is necessary to find the reason for the side effect. Dietary supplement samples labelled as containing tejocote were analysed using mass spectrometry and DNA barcoding analysis. Our results demonstrate that Alipotec samples contained ingredients from different species, yellow oleander instead of tejocote. The rpoB barcode region was able to differentiate between tejocote and yellow oleander species. Moreover, it was also observed that three compounds, including thevetin B, neriifolin, and digitoxigenin, clearly distinguish between tejocote and yellow oleander samples. This is the first and preliminary investigation to use an integrated approach of both chemical and genomic profiling for the authentication of dietary supplement containing tejocote.

Immune thrombocytopenic purpura caused by the over-the-counter weight supplement Root of Tejocote (Crataegus species).

Over-the-counter supplements, such as Alipotec which often purported to amplify weight loss and readily available in naturopathic shops, can have clinically significant patient outcomes including severe cytopenia, and even inducing immune thrombocytopenic purpura.

Crataegus mexicana (Tejocote) Exposure Associated with Cardiotoxicity and a Falsely Elevated Digoxin Level.

INTRODUCTION: A species of hawthorn, Crataegus mexicana (tejocote), has been marketed as a weight-loss supplement that is readily available for purchase online. While several hawthorn species have shown clinical benefit in the treatment of heart failure owing to their positive inotropic effects, little is known about hawthorn, and tejocote in particular, when consumed in excess. We describe a case of tejocote exposure from a weight-loss supplement resulting in severe cardiotoxicity. CASE REPORT: A healthy 16-year-old girl presented to an emergency department after ingesting eight pieces of her mother's tejocote root weight-loss supplement. At arrival, she was drowsy, had active vomiting and diarrhea, and had a heart rate of 57 with normal respirations. Her initial blood chemistries were unremarkable, except for an elevated digoxin assay of 0.7 ng/mL (therapeutic range 0.5-2.0 ng/mL). All other drug screens were negative. She later developed severe bradycardia and multiple episodes of hypopnea that prompted a transfer to our institution, a tertiary pediatric hospital. Her ECG demonstrated a heart rate of 38 and Mobitz type 1 second-degree heart block. She was subsequently given two vials of Digoxin Immune Fab due to severe bradycardia in the setting of suspected digoxin-like cardiotoxicity after discussion with the regional poison control center. No clinical improvement was observed. Approximately 29 hours after ingestion, subsequent ECGs demonstrated a return to normal sinus rhythm, and her symptoms resolved. DISCUSSION: Tejocote root toxicity may cause dysrhythmias and respiratory depression. Similar to other species of hawthorn, tejocote root may cross-react with some commercial digoxin assays, resulting in a falsely elevated level.