AIIMS Nov 2006 Clinical Sciences MCQ 94

• Pyrrolizidine alkaloids (PAs) are hepatotoxins found in many species of plants throughout the world.
  
• Most cases of pyrrolizidine alkaloid toxicity result in moderate to severe liver damage.
• Gastrointestinal symptoms are usually the first sign of intoxication, and consist predominantly of abdominal pain with vomiting and the development of ascites.
  
• Death may ensue from 2 weeks to more than 2 years after poisoning, but patients may recover almost completely if the alkaloid intake is discontinued and the liver damage has not been too severe.

• Epidemic dropsy is a form of edema due to intoxication with Argemone mexicana (Mexican prickly poppy).
• In Northern India, epidemic dropsy occurs as a food adulterant disease where use of mustard oil as cooking medium is common.
  
• When mustard oil is adulterated deliberately (as in most cases) or accidental contamination with argemone oil, proteinuria (specifically loss of albumin) occurs, with a resultant edema as would occur in nephrotic syndrome.
  
• Other symptoms are headache, nausea, loose bowels, erythema and breathlessness.
• In severe cases fatalities are reported due to congestive heart failure.
• The toxic effects of argemone oil have been attributed to the presence of benzophenanthridine alkaloids, sanguinarine and dihydrosanguinarine.
  
• It has been reported that the sanguinarine alkaloid content in argemone oil varies from 0.44% to 0.50%.

• Aflatoxins are naturally occurring mycotoxins that are produced by many species of Aspergillus, a fungus, most notably Aspergillus flavus and Aspergillus parasiticus.
• After entering the body, aflatoxins are metabolized by the liver to an reactive intermediate, aflatoxin M1, an epoxide.
• High-level aflatoxin exposure produces an acute necrosis, cirrhosis, and carcinoma of the liver exhibited by hemorrhage, acute liver damage, edema, alteration in digestion, and absorption and/or metabolism of nutrients
• Children, however, are particularly affected by aflatoxin exposure which leads to stunted growth and delayed development. Chronic exposure also leads to a high risk of developing liver cancer, as the metabolite Aflatoxin M1 can intercalate into DNA and alkylate the bases through its epoxide moiety.

• Ergot is the common name of a fungus in the genus Claviceps.
• Ergotism is the effect of long-term ergot poisoning, classically due to the ingestion of the alkaloids produced by the Claviceps purpurea fungus which infects rye and other cereals, and more recently by the action of a number of ergoline-based drugs.
  
• It is also known as ergotoxicosis, ergot poisoning and St Anthony's fire.
• Convulsive Symptoms: painful seizures and spasms, diarrhea, paresthesias, itching, headaches, nausea and vomiting. Usually the gastrointestinal effects precede CNS effects. As well as seizures there can be hallucinations and mental effects including mania or psychosis. The convulsive symptoms are caused by clavine alkaloids.
• Gangrenous symptoms: The dry gangrene is a result of vasoconstriction induced by the ergotamine-ergocristine alkaloids of the fungus. It affects the more poorly vascularized distal structures, such as the fingers and toes. Symptoms include desquamation, weak peripheral pulse, loss of peripheral sensation, edema and ultimately the death and loss of affected tissues.

Category: AIIMS Nov 2006 MCQs