POISONOUS PARTS
Whole plant.3,4
TOXICITY
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Toxic Constituents
Pyrrolizidine alkaloids such as senkirkine.2–4
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Toxic Dose
Long-term consumption of 1 mg pyrrolizidine alkaloids per day can be toxic.5
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Mechanism
Pyrrolizidine alkaloids are converted into highly reactive metabolites after transformation in the liver by the cytochrome P450 system. These metabolites bind to proteins, DNA and RNA, and induce acute and chronic toxicities. Liver is the major organ affected, and veno-occlusive disease (Budd-Chiari syndrome) could occur. As liver metabolism is involved, toxicity is not strictly dose-dependent but shows individual variability.6,7
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Poisoning Features
Pyrrolizidine alkaloid poisoning has acute and chronic effects. Acute: abdominal pain, hepatomegaly, ascites, liver necrosis and even death. Chronic: hepatomegaly, recurrent ascites, hepatic vein occlusion (Budd-Chiari syndrome), cirrhosis, hepatocellular carcinoma, pulmonary hypertension and even death.5,6
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Poisoning Events
Consumption of cereal grains contaminated by pyrrolizidine alkaloid-containing plants and the use of such plants for medicinal or dietary purposes were the main causes of such poisoning.5,6
CLINICAL MANAGEMENT
Supportive treatment. Early diagnosis and avoidance of further exposure to the toxins is important.7
IDENTIFICATION FEATURES
Annual herbs, 15–40 cm tall. Leaves green adaxially, purplish abaxially; lower leaves 4.5–11 × 2–6 cm, lyrately lobed; uppermost leaves 3.5–6 cm long, amplexicaul. Capitula 3–5 mm in diameter, 2–5 heads arranged in loose corymbs. Involucres as long as the inside florets, or covering more than 5/6 of the florets. Cypselae 3–3.5 × 0.5 mm, 5‑angulate, puberulous; pappus white.8
MEDICINAL USES
Whole plant used in TCM: clear heat, induce diuresis, cool blood, remove toxin, dissipate stasis and disperse swelling. Recommended dose: 9–18 g.2,9
CASES IN TRL
A 10-month-old boy took an herbal broth prepared with E. sonchifolia on and off for 3 months for health enhancement. He presented with ascites, pleural effusion and hepatomegaly. Ultrasonography revealed a thrombosed right hepatic vein. The clinical features and image findings were consistent with Budd-Chiari syndrome. Senkirkine, a pyrrolizidine alkaloid, was detected in the plant specimen. The patient recovered after stopping the exposure.10
LABORATORY ANALYSIS
Senkirkine can be detected by GC-MS and LC-MS/MS.11,12
