Attempted Suicide by Cerbera odollam Ingestion in Switzerland: A Case Report

We report the case of a 37-year-old female patient admitted to our hospital with unstable bradyarrhythmia, abdominal cramping, vomiting and visual disturbances including xanthopsia and diplopia. Ten hours prior to admission, she reported ingestion of four seeds of Cerbera odollam and four crushed nutmegs with suicidal intent. The patient was hypotensive and suffered from hyperkalemia (serum potassium > 5.5 mmol/L), leucocytosis and acute kidney injury. Her heart rate ranged between 28 and 40 bpm, and electrocardiogram (ECG) revealed a second-degree atrioventricular (AV) block and ST-depressions. The patient developed a third-degree AV block requiring vasopressors and transvenous pacing, which she remained completely dependent upon for 56 h. After a total of 3 days, the patient remained hemodynamically stable, and the pacemaker was removed. ECG still featured downsloping ST-depressions, first-degree AV block and sinus bradycardia. The patient survived. Her clinical course was typical and severe. Cerbera odollam poisoning is a potentially fatal condition associated with arrhythmia, abdominal symptoms and electrolyte disturbances. It remains a rarity in Europe and hardly known to Western physicians. Given its potentially lethal effects and increasing availability of its seeds, Cerbera odollam poisoning must be included in the differential diagnosis of unknown intoxications. With this case report, we hope to raise awareness among physicians for Cerbera odollam intoxications in Europe.