'Herbal cleanser' found to be cause of cardioactive steroid poisoning

February 26, 2003

Eight hours after a 36-year-old woman ingested an herbal product marketed for its "internal cleansing" properties, she experienced acute cardioactive steroid poisoning, with symptoms of nausea, hyperkalemia (high potassium levels), a junctional bradycardia (slow heart rate), and other heart-rate changes, according to a case report in the March 2003 issue of Annals of Emergency Medicine. (Cardioactive Steroid Poisoning From an Herbal Cleansing Preparation, p. 396)

The patient, described in this report by New York City Poison Control Center researchers, purchased the herbal product from a New York City street vendor. The ingredients were neither known to the patient nor listed on the product packaging; however, the authors note the product claims to be created from plants picked from the Amazon jungle. The product also appeared be commercially produced and not a home-packaged herbal product.

The patient said she ingested the entire contents of the package, although the directions included with the product stated it should be divided into four doses.

The authors believe it is possible that the herbal product was contaminated with Digitalis lanata (foxglove plant) or some other plant-derived cardioactive steroid, which can be very toxic and fatal with an overdose. Contained in the leaves of the foxglove plant is a major cardioactive steroid, which is metabolized into digitoxin, used in drugs today to treat some heart problems because it slows down and controls the heart rate. Digitalis lanata also has been used both medicinally and as a poison since the time of ancient Egypt and the Roman Empire.

This patient was treated similarly to an acute digoxin overdose with antidotal therapy, digoxin-specific Fab fragments, and had a full recovery. Further testing found mostly digitoxin metabolites and some digoxin in the patient's serum.

American College of Emergency Physicians

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