Abstract

INTRODUCTION

Bottle gourd juice is considered as a panacea in traditional Indian medicine. It has been used in the management of hyperlipidemia, diabetes mellitus, constipation, urinary tract infections, hepatic infections, cardiovascular disease. This juice may sometimes turn bitter due to increased levels of a toxic compound known as Cucurbitacin. This bitter juice if consumed can lead to toxic effects in GI tract like abdominal pain, vomiting, hematemesis, decreased blood pressure that may be harmful specifically to patients with co-morbidities.

CASE DESCRIPTION

 

A 64-year-old female was referred to our hospital in a state of shock. She came with a history of multiple episodes of vomiting, 2 episodes of hematemesis, altered sensorium and decreased blood pressure within few hours of consumption of bitter bottle gourd juice in the morning. She was conscious, confused with pale, cold and clammy skin in her extremities. Her vitals were not normal. Nasogastric tube was inserted, and the aspirate obtained was brown in color. Examination revealed abdominal tenderness with no visceromegaly. The investigation on admission showed renal and liver dysfunction, leukocytosis and hyperkalemia. Examination of the urine sample was normal. Liver was enlarged, showed fatty changes. Electrocardiogram revealed sinus tachycardia. She was resuscitated and was given fluids by intravenously with antibiotics and supportive treatment. Her condition gradually improved with her vitals returning to normal range.

 

DISCUSSION

Cucurbitacin D increases capillary permeability. When the levels of cucurbitacin exceed 130ppm it causes toxicity. About 50-300 ml of juice can lead to clinical manifestations and the severity is dose dependent. Most patients present within 1 hour of consumption with abdominal pain, vomiting, diarrhea, hypotension and hematemesis or melena. According to our case presentation we consider the following differential diagnosis:

1.Sepsis with multiorgan dysfunction

2.Food poisoning

3.GI bleed

4.Cardiac causes

We consider the possibility of bottle gourd poisoning as a probable diagnosis due to the Naranjo adverse drug reactions probability scale. Since there is no specific antidote available for this toxicity, management is mostly supportive with intravenous fluids, control of bleeding and management of shock.