POISONOUS PARTS
Fruits and seeds.1,2,4,5
TOXICITY
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Toxic Constituents
Arecoline, arecaidine and tannins.4,6
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Toxic Dose
1 areca nut can cause mild acute toxicity with significant individual variability.7
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Mechanism
Arecoline and the derived nitrosamine are considered carcinogenic. Arecaidine, formed by hydrolysis of arecoline, can lead to oral submucous fibrosis with resultant risk of malignant transformation. Arecoline and related alkaloids are also agonists to muscarinic acetylcholine receptors. Tannins may be synergistic in the pathogenesis of oral submucous fibrosis.6–8
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Poisoning Features
Acute toxicity: salivation, nausea, vomiting, abdominal pain, sweating, dizziness, palpitation, tachycardia, hypotension, dyspnoea , drowsiness, coma. Chronic use (chewing): oral submucous fibrosis, oral cancer.4,6,7,9
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Poisoning Events
Oral submucous fibrosis and oral cancer associated with chronic areca nut chewing is well documented worldwide, particularly in Taiwan and India. Acute toxicities have also been reported in 17 cases in Taiwan after taking 1–100 areca nuts for recreational, medicinal or suicidal purposes.6,7,9
CLINICAL MANAGEMENT
Supportive treatment for acute toxicity.7
IDENTIFICATION FEATURES
Large palms, up to 20 m tall. Stems solitary, unbranched, grey, with conspicuous leaf scar rings. Leaves pinnate, fascicled at apex of stem; pinnae 30–60 × 2.5–4 cm, pinnae 20–30 per side of rachis. Inflorescence up to 25 cm long, much-branched; one or two rows of male flowers per rachillae, female flowers solitary at bases of rachillae. Fruits 3–5 cm long, orange. Seeds ovoid.10
MEDICINAL USES
Seeds used in TCM: expel parasites, relieve accumulation, move qi, induce diuresis, control malaria and relieve nausea. Recommended dose: 3–10 g.2,11–13
LABORATORY ANALYSIS
Arecoline and arecaidine can be detected by HPLC-DAD, GC-MS and LC-MS/MS.14–16
