Simultaneous death of two siblings, a Senna matter?

Area of Science:

• Toxicology
• Pharmacology
• Forensic Medicine

Background:

• Senna is a widely used herbal laxative and weight loss aid.
• Chronic Senna ingestion is linked to adverse effects, including persistent diarrhea and rare cases of liver failure.
• Limited data exists on fatalities potentially associated with Senna misuse.

Purpose of the Study:

• To report and analyze two simultaneous fatalities potentially linked to chronic Senna consumption.
• To identify analytical biomarkers for Senna exposure in post-mortem samples.
• To discuss the forensic implications of Senna use in unexplained deaths.

Main Methods:

• Confirmation of Senna identification in leaf samples by detecting sennosides.
• Analysis of biological samples (urine, bile, feces) for Senna metabolites (rheinanthrone, aloe-emodin).
• Clinical correlation of symptoms and analytical findings in two deceased siblings.

Main Results:

• Senna identification was confirmed in the consumed leaves.
• Senna metabolites, rheinanthrone and aloe-emodin, were detected in the siblings' biological samples, confirming exposure.
• Analytical data confirmed Senna use but did not definitively prove toxicity as the sole cause of death.

Conclusions:

• Rheinanthrone and aloe-emodin serve as potential biomarkers for Senna exposure, particularly in urine.
• While Senna use was confirmed, the direct causal link to fatalities remains presumptive.
• The simultaneous nature and similar clinical presentation of deaths strongly suggest Senna exposure as a primary hypothesis in this forensic investigation.