Журнал клинической токсикологии
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Food-induced Hypotension and Bradycardia: A Case Report

Mark Richman, Timothy Tong, Rachel Moss, Akiva Dym, Michael Connolly and Adam Berman

A 64-year-old woman with no past medical history presented with tongue numbness, perioral tingling, palmar pruritus, and multiple episodes of emesis and diarrhea beginning 15 hours prior to arrival. Blood pressure was 88/30 mm Hg; EKG showed sinus bradycardia (40 bpm). Normal saline and atropine 0.5 mg were administered intravenously; heart rate improved to 69 bpm and blood pressure to 104/38 mm Hg. When her heart rate and blood pressure again declined, dopamine (10 mcg/kg/min) was started. Vital signs improved to blood pressure 129/44 mmHg, heart rate 57 bpm. Family revealed that, 24 hours prior to presentation, she consumed a Brazilian candlenut tree seed laxative supplement. She was admitted on a dopamine drip (10 mcg/kg/min). Dopamine was weaned as her vital signs self-normalized. She was discharged on hospital day 8. Brazilian candlenut toxicity is uncommon and can easily be misdiagnosed and improperly treated. Other items on the differential diagnosis for bradycardia, hypotension, and gastrointestinal symptoms are more common; therefore, candlenut toxicity would be easy to miss, particularly among patients concurrently taking other agents with a similar toxicity profile (eg. digoxin). Treatment is symptomatic, with inotropic and vasopressor support as needed (eg. intravenous hydration, antiemetic medications, electrolyte replacement, and dopamine drip).