Uncommon Food Poisoning

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Uncommon Food Poisoning

• Dr LAU Fei-lung
• COS (AED) UCH

2
(Natural) toxins in food (plants)

• Cyanogenic glycoside
• Beans
• Potatoes
• Fresh Jin Zhen
• Star fruit
• Aflatoxin
• Ackee fruit

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1) Cyanogenic glycoside

• Phytotoxin in 2000 plants
• 25 cyanogenic glycosides
• From 4 amino acids or nicotinic acid
• Cyanogenic glucose Aldehyde or ketone
• glycoside
• cyanohydria HCN
• ß-glycosidase spontaneous or
• hydroxynitrile lipase

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1) Cyanogenic glycoside

• Acute HCN toxicity Headache, dizzy, mental
  confusion, stupor, twitching , convulsion, coma.
• Lethal dose 0.5-3.5 mg /kg
• Chronic HCN toxicity
• Goitre and cretinism HCN converted to
  thiocyanate interfere with thyriod Iodine uptake
  
• Tropical toxic neuropathy

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Fruit seeds or stone

• Seeds of apple, apricots, plum,
• prunes, cherries, peaches
• Flesh of fruit not toxic
• Kernals in pits chewed
• Release hydrogen cyanide from Amygdalin
• Lethal dose 0.5-3mg/kg
• Bitter almond??poisoning commonest

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Fruit seeds or stone

• 6 mg HCN/ bitter almond
• 5-10 raw almonds fatal for
• young children
• Mis-belief Amygdalin can prevent cure cancer
• Lady with cancer on 4 amp of laetrile (3g
  amygdalin) daily, die with 24 hrs after ingestion
  of 3.5 ampoules.

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Cassava poisoning ?in Philippine

• 9/3/05 after taking fried
• cassava ball
• 500 pupils sick , 30 died
• ?cyanide poisoning ( ill prepared cassava)
• Use white (bitter) cassava flour
• Later prove to be organophosphate poisoning
• Diarrhoea, salivation , frothing , convulsion ,
  small pupils
• Pesticide bottle to contain cooking oil .

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Cassava (??)

• Grow in tropical climate
• (important root crop in Pacific island, Latin
  America, Africa some Asian countries)
• Tuber root (30 starch) leaves

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Cassava (??)

• Poisoning also seen in China
• under/uncooked cassava
• Contain linamarin glucose, Acetone
  HCN
• Cyanide Content Processing
• Sweet cassava 15 50 mg/kg Peeling full
  cooking
• Better cassava 50 400 mg/kg Heap
  fermentation

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• 1?11?,??????????????,19??????????????(?????)??????
  ??????????,??????,??????????????
  ?????????????????????,????????????????????????

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Bamboo Shoots

• 1200 bamboos, limited edible
• Contain Taxiphyllin
• glucose, HCN hydroxybenzaldehyde
• 1000 mg/kg in apical part
• 8000 mg/kg in immature shoot tip
• Reduced markedly after harvesting
• Cooking for 2 hrs HCN to 3

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Cycas Seed (??????)

• Contain Cycasin Neocycasin
• Reported in PCC Taiwan
• 21 cases 1990-2001
• 70 mistaken as edible food,
• others health promotion,
• cancer prevention, cosmetic use
• Washed cooked

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Cycas Seed

• Onset of symptom 30 min
• to 7 hours
• Ingested 1 to 30 seeds
• Nearly all develop G.I. Symptom (vomiting)
• All recovered in 24 hours
• Blood cyanide thiocyanate elevated but not
  toxic

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2) Beans

• Green bean ???
• Phytohaemagglutin
• destroyed by soaking cooking
• Onset 1-3 hours
• Symptoms nausea, vomiting diarrhoea
• Partial cooking to 80oC even more toxic

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Castor Bean (????)???

• Contain ricin in mash after
• bean processed to caster oil
• Potent cytotoxin inhibit ribosomal protein
  synthesis
• Weak haemagglutinin
• Lethal dose 1mg (oral) 0.5mg (injection)

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Castor Bean

• 1 seed can kill a child (not toxic if swallow
  unchewed)
• Bulgarian writer in 1978, killed by KGB with
  ricin pellet
• S/S depend on route of exposure

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Ricin

• Ingestion
• Vomiting, bloody diarrhoea, abd pain
• Within 6 hours
• Progress to dehydration shock
• Followed by brain, liver, kidney failure
• Death within 36-72 hours
• Inhalation
• Delay of 8-18 hours
• Cough, SOB, weakness, fever, ARDS
• dermal
• dermatitis

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3) Potatoes

• Contain glycoalkaloid
• solanine (???)
• Usually low level non-toxic
• Greening, sprouting, rotting toxin
• Bitter taste
• Solanine cannot destroyed by cooking

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3) Potatoes

• Cause oral burning sensation, severe abdominal
  pain vomiting
• Can cause respiratory depression, cerebral edema
  haemolysis

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4) Fresh Jian Zhen (???)

• Bud of some lily harested
• before blossoming
• Flower roots contain colchicine
• Inadequate soaking cooking
• Cause abdo pain, vomiting diarrhoea
• Commercial dry Jin Zhen colchicine destroyed
  during processing

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5) Star Fruit

• Averrhoa carambola
• Tropical fruit popular in Asia
• In uraemic patient
• Cause hiccup, confusion,
• convulsion , agitation
• Treatable by intensified dialysis

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5) Star Fruit

• Postulated related to oxalate
• Healthy patient develop acute oxalate nephropathy
  (ARF) ingesting large amount sour star fruit
  juice
• Star fruit high oxalate content precipitate in
  brain causing neurological symptom

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6) Aflatoxins(?????)

• Toxin produced by Fungi
• Aspergillus Flavus A. parasiticus green mould
• Grow an mouldy hay, grain peanuts
• Aflatoxinheat resistant no taste/smell/color

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6) Aflatoxins (?????)

• Acute poisoning vomiting, abdominal pain,
  pulmonary edema, convulsions coma, death with
  cerebral edema fatty liver, heart kidney
• Chronic chronic liver disease CA liver

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6) Aflatoxins (?????)

• Accepted limited in HK
• 20 mg/kg peanut oil
• 15 mg/kg other food
• FEHD survey (1998-2000)
• 526 food samples
• 23 peanut peanut oil ve (1.6 20.0 mg/kg)

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Jamaican Vomiting Sickness-Ackee friut

• Endemic in Jamaica
• and Africa (/- USA)
• Acute illness with intractable vomiting
  ,convulsion and coma associating with
  hypoglycaemia and acidaemia

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Jamaican Vomiting Sickness

• 2-6 hours after eating
• Ackee Fruit
• Unriped ackee fruit contains hypoglycins A and B
  
• Cause hypoglycaemia by binding carnitine and
  Coenzyme A