Cerbera manghas 海杧果

POISONOUS PARTS

Whole plant, especially the fruits and seeds.³

TOXICITY

• Toxic Constituents

  Cardiac glycosides such as cerberin, cerberoside and thevetin.⁴

• Toxic Dose

  Reported lethal dose: half a seed.⁵

• Mechanism

  Cardiac glycosides inhibit Na⁺/K⁺-ATPase of the myocardium, increase its excitability and may lead to arrhythmias.^6–8

• Poisoning Features

  Digitalis-like toxicity such as nausea, vomiting, abdominal pain, dizziness, headache, hypotension, arrhythmias, hyperkalaemia, agitation, confusion, convulsion, coma and even death.^5,9

• Poisoning Events

  Poisoning cases due to accidental ingestion, or using C. manghas as a means of suicide or murder, had been reported in China, Sri Lanka and India.^5,10,11

CLINICAL MANAGEMENT

Supportive treatment. Multiple-dose activated charcoal therapy has been used for gastrointestinal decontamination in cardiac glycoside poisoning, and digoxin-specific antibody has been used as an antidote.^12,13

IDENTIFICATION FEATURES

Small evergreen trees, up to 8 m tall, with milky sap. Leaves thickly papery; leaf blades 6–37 × 2.3–7.8 cm, light green abaxially, lateral veins 20–30 on each side of midvein. Flowers 4–7 cm in diameter. Corolla white, with a pink eye; tubes 2.5–4 cm long, villous inside; lobes 1.5–2.5 cm long. Drupes about 5.8 × 4–6 cm, red when ripe, epicarp cellulosic or woody.¹⁴

LABORATORY ANALYSIS

Cerberin and thevetin can be detected by LC-MS/MS.^15,16