Cleistanthus collinus poisoning: a case report of intentional poisoning

• Published in: BMJ case reports Vol. 12; no. 2; p. bcr-2018-228197
• Main Authors: Bompelli, Nandakishore, Reddy C, Rakesh, Modani, Santosh, Deshpande, Anirudda
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.02.2019; BMJ Publishing Group
• Series: Case Report
• Subjects: Acidosis; Acidosis - chemically induced; Acidosis - therapy; Antidotes - therapeutic use; Case reports; Charcoal - therapeutic use; Fatal Outcome; Gastric Lavage - methods; Humans; Intensive care; Language; Male; Malpighiales; Metabolism; Middle Aged; Plant Extracts - poisoning; Poisoning; Poisoning - etiology; Poisoning - therapy; Poisons; Rare Disease; Renal Replacement Therapy; Respiratory distress syndrome; Respiratory Distress Syndrome - chemically induced; Respiratory Distress Syndrome - therapy; Suicide; Africa; India; toxicology; poisoning
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2018-228197

We report a case of 50-year-old male patient from tribal area in South Indian state of Telangana, who ingested the liquid extract from crushed leaves of the plant, cleistanthus collinius with the intention of self-harm. Immediate gastric lavage and activated charcoal administration was done and the patient was subsequently admitted into an acute medical care unit. During first 24 hours of monitoring, the patient was clinically stable. There was mild normal anion gap metabolic acidosis and hypokalaemia on arterial blood gas (ABG) and was corrected accordingly. On second day of admission he developed acute onset shortness of breath. Chest auscultation revealed extensive bilateral coarse crackles. Chest X-ray was suggestive of acute respiratory distress syndrome (ARDS). The patient had to be intubated. Continuous renal replacement therapy (CRRT) was initiated in view of worsening metabolic acidosis and unstable haemodynamics. In spite of appropriate intensive care measures, the patient succumbed to illness. Immediate gastric lavage and activated charcoal administration was done and the patient was subsequently admitted into an acute medical care unit. During first 24 hours of monitoring, the patient was clinically stable. There was mild normal anion gap metabolic acidosis and hypokalaemia on ABG and was corrected accordingly. On second day of admission, he developed acute onset shortness of breath. Chest auscultation revealed extensive bilateral coarse crackles. Chest X-ray was suggestive of ARDS. The patient had to be intubated on day 2. CRRT was initiated in view of worsening metabolic acidosis and unstable haemodynamics. In spite of appropriate intensive care measures, the patient gradually deteriorated, had cardiac arrest and passed away on day 5 of his hospital stay.