Podophyllin Toxicity Often Misdiagnosed

December 26, 2009, 3:20 pm

★★½☆☆

BAJIAOLIAN POISONING – A POISONING WITH HIGH MISDIAGNOSIS RATE Chou SL et al. Am J Emerg Med 2010 Jan;28:85-89.

Abstract

Bajiaolian, one of the species of mayapple plants, contains podophyllin and has long been used in Chinese herbal medicine to treat skin lesions, snake bites, generalized weakness, and other conditions.  Ingestion of podophyllotoxin produces early gastrointestinal manifestations (nausea, vomiting, diarrhea,  abdominal pain) followed by neurologic deficits (sensory-motor neuropathy, ataxia) that can be prolonged.  Bone marrow suppression can also occur. This retrospective review from Taiwan identified 17 patients with bajiaolian poisoning in poison center records covering July 1985 to March 2003.  Only two of these 17 patients were given the correct diagnosis at their initial encounter with medical practitioners; 14 of these patients were initially diagnosed as gastroenteritis. This is an interesting poisoning to be aware of, but since podophyllin toxicity is only rarely seen in the U.S. this article is not essential reading. The retrospective review is weakened by the same problem found in may studies of herbal toxicity — it is impossible to know exactly what toxin or toxins these patients were exposed to.  In adition, the paper  is written in a very confusing fashion, as if it were translated (poorly) from some obscure foreign dialect.

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