Rotundin poisoning: diagnosis and aggressive resuscitation treatment

Rotundin is extracted from the tubers of lime with the main ingredient L tetrahydropalmatine, which has sedative, analgesic, and sleep-inducing effects. It is a safe drug, but if taken in excess, it can cause many complications.

Rotundin

Doses for sedation range from 30-90mg, an analgesic dose of 60-120mg, the maximum can be used up to 480mg/day. The exact dose of poisoning has not been documented. However, according to our study, when the patient took 300mg/24 hours, there were changes in the electrocardiogram.

Definite diagnosis

Ask the patient

Detection of longan with rotundin ingestion.

Clinical symptoms

Nervous system: central nervous system depression, decreased consciousness, severe leading to coma, a few patients excited.

Respiratory: Respiratory depression, aspiration pneumonia.

Cardiovascular: most have disturbances on electrocardiogram, the most common are ST elevation, negative or biphasic T, prolonged QTc, possibly bradycardia, sinus or sinus tachycardia, atrioventricular block, hypotension.

Gastrointestinal: nausea, vomiting, can cause hepatitis but mainly in patients on prolonged therapy.

Test

Toxicology: found rotundin in gastric juice, urine. Determination of rotundin in blood by liquid chromatography-mass spectrometry.

Electrocardiogram: record the electrocardiogram at admission and at discharge, when there is an abnormality in the electrocardiogram, it is necessary to monitor the ECG every 6-12 hours by monitor.

Differential diagnosis

With other hypnotics and sedatives: toxicology testing.

Distinguish from other causes of coma.

Treatment

Follow emergency steps to stabilize the patient if the patient is critically ill.

There is no specific antidote.

Limit absorption.

• Induce vomiting if come early, love completely.
• If there is a disturbance of consciousness: gastric lavage after intubation with balloon tamponade, with a maximum amount of washing water from 3 to 5 liters.
• Activated charcoal 1g/kg, drink once with bleach.
• Sorbitol bleach: 1-2g/kg.

Recovery:

• Ensure breathing: patients with impaired consciousness: put the patient in a safe position, avoid tongue drop, suck sputum, breathe oxygen if necessary.
• If there is coma, respiratory failure: conduct endotracheal intubation, CMV ventilation.
• Infusion: enhance elimination of toxins, use 0.9% sodium chloride; glucose 5%.
• Nourish, clean the body, anti-ulcer.
• Monitor electrocardiogram, discharge when QTc tends to decrease and return to normal.