A report of lupinus mutabilis anticholinergic toxicity

• Published in: Clinical toxicology (Philadelphia, Pa.) Pa.), 2005-10, Vol.43 (6), p.763-763
• Main Authors: Smith, S W, Halcomb, SE, Hoffman, R S, Nelson, L S
• Format: Article
• Language: English
• ISSN: 1556-3650

Herbal supplements are used worldwide as home-remedies for multiple ailments. Patients develop unusual toxidromes after consuming these remedies, which presents a diagnostic dilemma for physicians. We present a case of poisoning due to misuse of lupine seeds as an herbal therapy. A 28-year-old woman presented to the ED complaining of blurry vision and photophobia. Twelve hours earlier she ingested a glass of liquid prepared by rehydrating dried Ecuadoran lupine beans - used as a natural purgative in her native country. Gastric distress followed 3 hours later, and was so severe that she attempted to induce emesis. A review of systems was also remarkable for a dry mouth and headache. Vital signs were: BP, 120/80 mmHg; P, 88/min; RR, 18/min; and T 98.0 degree F. She had poorly reactive 7 mm pupils, a normal funduscopic examination, and a dry oropharynx. The remainder of her examination was normal. She received one dose of activated charcoal and 650 mg of acetaminophen for her headache and was observed for 3 one half hours. At discharge her symptoms were resolving and her pupils were more reactive. A sample of the patient's beans was subsequently identified as Lupinus mutabilis. L. mutabilis contains high levels of lupanine, 13-hydroxylupanine, 4-hydroxylupanine, and sparteine - quinolizidine alkaloids which produce anticholinergic toxicity in humans. Quinolizidine alkaloid content and composition vary by species, germination time, and maturation environment. Varieties with a high quinolizidine alkaloid content require extensive boiling and washing. This patient's consumption of lupine quinolizidine alkaloids in the rehydrating solution resulted in toxicity. This case highlights the hazards when natural products are used outside of their traditional region. Simple substitution of a similar species can result in significant toxicity. Our case illustrates the use of an herbal remedy causing an atypical toxidrome. Physicians who encounter patients with an atypical syndrome should be aware that different cultural practices may influence the presentation.