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A Toxic Nut

Sean Nordt, MD PharmD FAAEM, Stuart Swadron, MD, FRCPC, and Matt Hendrickson, MD
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14:33
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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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02:42

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EM:RAP 2020 02 February Written Summary 257 KB - PDF

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Dallas Holladay, DO -

We had a similar case when I was a resident. Most hospitals, including large academic centers, will not have the digibind required. This patient recieved 10 vials of digibind and still expired. Silver lining, one of our pediatricians got pong pong seeds pulled from Etsy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075506/

A moot point but seems pretty unlikely suicide was not the patient's intent, sadly. Any minimal Googling rapidly reveals this as method of suicide with little other use.

Sean N. -

Hi Dallas,

Thank you for the comment and the information on the case when you were a resident

We do not know the true mortality rate with Cerbera odollam (pong pong) but there are several cases of death reported in the literature from cases in the United State. Though much more of a widespread problem in parts of Asia and India where it is ingested most commonly for suicide AKA "suicide tree" whereas in the United States as the one presented, it being taken as a weight loss supplement

Sean

Matt H. -

Thanks for the great comments, Dallas! Suicide is definitely a possibility in this case but perhaps less likely because she called the medics herself and then met then outside her apartment because she was so anxious to get help for her intractable vomiting. Speaking to Mom after she expired, she did not mention any history of depression. Regarding getting Pong Pong pulled from the Etsy market, high praise to your pediatric colleague. Bizarre that natural products can be so loosely regulated.

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