Clinical Characteristics of Acalypha indica Poisoning

Figures & data

Table 1 Demographic and Exposure Characteristics of Patients with Acalypha indica Ingestion

Characteristics	Frequency (%)
Age (years), median (min-max)	61.5 (38–70)
Gender: Male	7 (87.5)
Used parts of plant: Leaves	6 (75)
Whole: leaves, stem, roots	2 (25)
Preparation for consumption:
Boiled	4 (50)
Fresh juice	3 (37.5)
Both	1 (12.5)
Frequency of ingestion (times)	2 (1–6)
Onset of symptoms after the 1st dose ingestion:
1-time ingestion (hours), median (min-max)	1.5 (0.2–4)
≥2-time ingestion (days), median (min-max)	3 (2–4)
Time presenting to hospital (days)	2.5 (2–4)
Hospital stay (days), median (min-max)	10 (2–21)

Table 2 Demographic Data, Clinical Manifestations, Laboratory Results and Treatment in Each Patient Who Exposed to Acalyha Indica

Characteristics	Patient 1	Patient 2	Patient 3^a	Patient 4	Patient 5	Patient 6	Patient 7	Patient 8
Patient characteristics
Gender/Age (years)	F/47	M/38	M/70	M/68	M/61	M/64	M/62	M/56
Underlying disease	NA	None	Asthma/COPD/CAD	HT/BPH/Hyperthyroid	Renal calculi,HT, Old CVA	HT, BPH	HT	NA
Time presenting to hospital since exposure (days)	3	2	3	2	3	4	2	2
Uses of plant
Purpose	Asthma	Health supp.	Health supp.	Muscle pain	Health supp.	Allergy	Rash/Pruritus	Constipation
Used part	Whole	Leaves	Leaves	Leaves	Leaves	Leaves	Whole	Leaves
Preparation for consumption	Fresh juice	Both	Fresh juice	Boiled	Boiled	Boiled	Fresh juice	Boiled
Frequency of drinking (times)	1	1	3 (1x3 days)	1	3 (1x3 days)	4 (1x4 days)	1	4–6 (2x2-3 days)
Laboratory results
Initial Hct/Lowest Hct (%)	19.0/19.0	11.0/10.5	32.0/32.0	30.0/13.0	32.0/27.0	30.4/23.1	26.0/19.0	31.0/19.7
Initial TBIL/Initial InBIL (mg/dL)	5.5/4.9	5.4/2.0	2.2/1.9	5.2/3.3	4.0/3.1	8.2/7.3	15.3/14.5	6.3/5.5
Max InBIL/TBIL same day (mg/dL)	4.9/5.5	5.8/6.9	1.9/2.2	6.1/7.1	7.3/4.0	7.3/8.2	14.5/15.3	8.5/9.5
G6PD at presentation/3 months after discharge	Normal/Def	Normal/NA	Normal/NA	Normal/NA	Normal/NA	Def/NA	Normal/NA	Normal/NA
Initial SpO2/Lowest SpO2 (%)	60/40	83/83	49/49	98/98	70/70	85/85	98/60	88/82
MetHb level (%)/Day after exposure	NA	NA	23.9/3	-	1.0/10	4.5/5	8.8/2	5.6/3
Initial SCr/Max SCr (mg/dL)	1.8/10.2	1/NA	0.9/2.1	6.8/12.3	1.6/18.5	0.8/0.8	0.7/0.7	1.2/1.2
AKI (yes/no)	Yes	NA	Yes	Yes	Yes	No	No	No
Methemoglobinemia diagnosis by (yes/no)
MetHb level	No	No	Yes	No	Yes	Yes	Yes	Yes
Oxygen saturation gap	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes
Desaturation not well responded to oxygen	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes
Cyanosis	Yes	No	Yes	No	No	No	No	No
Onset of symptoms after 1^st exposure (days)/Duration until symptoms subsided (days)
Dark urine	0.16/12	1/4	3/3	1/NA	3/NA	4/5	0.5/5	2/4
Hemolysis	3/5	2/5	3/4	2/10	3/12	4/7	2/5	2/4
Methemoglobinemia	3/5	2/3	3/5	–	3/6	4/4	2/5	2/5
Treatment (yes/no)
Oxygen therapy/Endotracheal intubation	Yes/No	Yes/No	Yes/Yes	Yes/No	Yes/Yes	Yes/No	Yes/No	Yes/No
Blood transfusion	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Methylene blue 1% intravenous	Yes	No	Yes	No	No	No	No	No
Hemodialysis	Yes	No	No	Yes	Yes	No	No	No
Hospital stay (days)	12	5	2	19	21	7	10	10

Note: ^aDead case.

Abbreviations: COPD, chronic obstructive disease; CAD, coronary artery disease; HT, hypertension; BPH, benign prostatic hyperplasia; CVA, cerebrovascular accident; NA, not applicable; Health suppl, health supplements; Def, deficiency; Hct, hematocrit; Max, maximum; TBIL, total bilirubin; InBIL, indirect bilirubin; mg/dL, milligram/deciliter; G6PD, glucose-6-phosphate dehydrogenase; SpO2, oxygen saturation by pulse oximetry; MetHb, methemoglobin; SCr, serum creatinine; AKI, acute kidney injury.

Figure 1 Clinical signs and symptoms at first presentation.

Table 3 Phytochemical Compounds in Acalypha Indica.¹

Lists of Phytochemical Compound
Acaindinin	Ellagic acid	Phenol, 24 BIS (1,1-Dimethylethyl)	Tannin	1H-Pyrrole-2,5-dione, 1-ethenyl
Acalyphamide	Flavonoid such as chrysin, hesperetin	Potassium Brevifolin carboxylate	Tectoquinone*	16 α, 17-dihydroxy-ent-kauran 19-oic acid
Acetonylgeraniin	Flindersin	Proline,3.4-didehydro-	Triacetonamine	2-methyl anthraquinone*
Aurantiamide	Ferulic acid	Quebrachitol	Trimethy[4-(1,1,3,3, Tetramethylbutyl) phenox] Silane	3,3′Methylene bis (4-hydroxyl coumarin)
Caffeic acid	Gallic acid	Propanenitrile,3- (5-diethylamino-1-methyl-3-pentynyloxy)	Tri-O-methylellagic acid	3,8-Nonadien-2-one, E
Catechol	Geranin	Quinine*	β-sitosterol acetate	−4,4′,5,5′,6,6′ hexahydroxy diphenic acid
Chebulagic acid	Glucogallin	Repandusinic acid	β-Sitosterolß-D-glucoside	4-Amino-3-methoxypyrazolo[3,4-d] pyrimidine
Clotrisiloxane, Hexamathyl-	Hydrogen cyanide	Resin	γ-Sitosterol
Corilagin	Inositol methyl ether	Stigmasterol	γ-Sitosterol acetate
Cyanogenic glucoside such as acalyphine, acalyphin amide	Kaur-en-18-oic acid	Succinimide	1,2,3,6-tetra-O-galloyl-β-D-glucose
Cysteine	N-methyl-3-cyanopyridones	Syringic acid	1,3-Dioxolane,4-Ethyl-5-Octyl-2,2-Bis (Trifluoromethyl)-, Trans

Note: *These compounds are reported to cause methemoglobinemia in previous studies.^15,16

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