POISONOUS PARTS
Whole plant.2
TOXICITY
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Toxic Constituents
Pyrrolizidine alkaloids such as integerrimine and usaramine.2,3
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Toxic Dose
Long-term consumption of 1 mg pyrrolizidine alkaloids per day can be toxic.4
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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.5,6
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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.4,5
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Poisoning Events
There were 2 main sources of pyrrolizidine alkaloid poisoning. The consumption of cereal grains contaminated by the toxic weeds had caused numerous poisoning in many countries. In Afghanistan alone, an estimated 8000 people were affected with more than 1600 deaths. The other source is the use of pyrrolizidine alkaloid-containing herbs for medicinal and dietary purposes, leading to poisoning in all parts of the world.4,5
CLINICAL MANAGEMENT
Supportive treatment. Early diagnosis and avoidance of further exposure to the toxins is important.6
IDENTIFICATION FEATURES
Perennial herbs, 0.3–1(–2) m tall. Petioles pubescent, base usually with pseudo‑stipules; leaf blades fleshy, 3.5–13(–23) × 1.2–5(–6.5) cm, densely pubescent on both surfaces. Capitula 1.5–2 cm in diameter, 3–5 heads in corymbs, erect at anthesis. Corolla tube filiform, orange-yellow, abruptly broaden into campanulate or cylindric form near summit. Cypselae 3–4 × 0.8 mm, brown; pappus white.7
MEDICINAL USES
Whole plant used in TCM: clear heat and cool blood, dissipate stasis and disperse swelling, activate blood and relieve pain, stanch bleeding. Recommended dose: 6–15 g.1,8
LABORATORY ANALYSIS
Integerrimine and usaramine can be detected by GC-MS and LC-MS/MS.9,10
