Gastrointestinal discomfort and hypotension in a patient with Reutealis trisperma seeds intoxication: A case report

RATIONALE: Reutealis trisperma is a plant belonging to the Euphorbiaceae family and Reutealis genus and is often mistaken for a plant of the genus Aleurites. Accidental ingestion of R trisperma seeds is relatively rare in Taiwan than that of Vernicia fordii. Mostly, the clinical course of R trisperma seed poisoning is similar to that of V fordii poisoning. Recent studies have shown that the median lethal dose 50 of R trisperma seeds in mice is approximately 4954 mg/kg. R trisperma seed extract has a significant effect on the autonomic nervous system by causing ptosis and disrupting breathing, and affects the central nervous system by reducing motor activity. PATIENT CONCERNS: A 51-year-old man with underlying gout and hepatitis B picked several seeds of R trisperma, which he misidentified at chestnuts, at an elementary school. He prepared soup by boiling 3 to 4 seeds and consumed it. He experienced abdominal pain, vomiting, and watery diarrhea with hypotension. DIAGNOSIS: R trisperma seeds intoxication. INTERVENTIONS: The patient was given a soft diet, input and output were recorded, and intravenous fluid supplements were administered. OUTCOMES: The patient was discharged after 3 days of hospitalization, once a relatively stable condition was achieved. LESSONS: Human poisoning by accidental consumption of R trisperma seeds is relatively rare in Taiwan. It may cause gastrointestinal symptoms and even hypotension. Patients can recover within 2 to 3 days of receiving proper treatment and intravenous fluid infusion.