HARROWING ORDEAL: A DELICACY TURNED TOXIC

Abstract

Introduction

“Umbut rotan”, or the shoots of rattans, are commonly used in Sarawakian cuisines. However, not all rattan shoots are safe for consumption. Here, we report a case of neurotoxicity and a case of death induced by “umbut matar”.

Case Description

A 63 year-old man with hypertension and dyslipidemia, presented with sudden onset of giddiness, body weakness, blurring of vision, and breathlessness after two hours following ingestion of a certain “umbut”. His wife also ate the “umbut”, had similar symptoms, but succumbed to her demise despite cardiopulmonary resuscitation commenced by their daughter. Upon assessment, the patient was tachypneic with left eye ptosis, dysarthria, dysphagia, and reduced muscle power of all limbs to four. His blood results were normal. In view of worsening neurotoxicity and respiratory distress, the patient was intubated and ventilated for three days. His neurological function gradually improved in the ward with supportive treatment, and he was discharged home after nine days.

Discussion

According to the Malaysian National Poison Centre, there are many subtypes of “umbut”, some are known to be neurotoxic and can be lethal if ingested. “Umbut matar” or Plectocomiopsis mira was the suspected culprit and few cases of similar poisoning had been reported in Kapit, Sarawak. It contains alkaloid, which is neurotoxic to humans causing seizures, incoordination, abdominal pain, vomiting, and death. To date, there is no antidote available for “umbut” poisoning and all treatments are symptomatic and supportive in nature. Gastric decontamination can be potentially useful in reducing the amount of toxin absorbed if done within an hour of ingestion. Managements are primarily based on the optimisation of airway, breathing, circulation, disability, and exposure (ABCDE) to ensure the best possible outcome.

Conclusion

The consumption of “umbut matar” could lead to food poisoning that causes neurotoxicity and death. Despite no available antidote, early intervention based on the principles of ABCDE can be life saving.