Journal of The Association of Physicians of India ■ Vol.

64 ■ October 2016 87

Bottle Gourd (Lagenaria Siceraria) Juice Poisoning

Pravin M Rathi1, Pinakin S Patel2

colocynth, bitter gourd, water melon,

Abstract etc. The ethanolic extract of L. siceraria
f r u i t s h o we d a n t i h e p a t o t o x i c a n d
We present the case of a young woman who presented to us with multiple
antihyperlipidemic activity in rats. 4
episodes of vomiting, followed by hematemesis and abdominal pain after
Bottle gourd fruit contains trace amount
consuming bottle gourd juice. The patient was resuscitated and stabilized with
of cucurbitacins specially types B,
fluids, proton pump inhibitors and antiemetics and discharged in stable condition. D, G, and H. Normally, the levels of
As a member of the Cucurbitaceae family, bottle gourd contains toxic tetracyclic cucurbitacins do not exceed 130 ppm. 5
triterpenoid compounds called cucurbitacins which are responsible for the bitter Cucurbitacins inhibit the bindings of
taste and toxicity. There is no known antidote for this toxicity, and clinicians treat cortisol to glucocorticoid receptor in
such patients symptomatically only. He La cells at 37 °C in a dose dependent
manner, showing a strong correlation
with cytotoxic activity. 3 Cucurbitacin
intravenous pantoprazole, ondansetron D enhances capillary permeability, 3
Introduction
and hyoscine, and 2 litres of isotonic which is associated with a persistent

T he calabash or bottle gourd normal saline infusion. After 2 litres fall in blood pressure and accumulation
(Lagenaria siceraria) is popularly of isotonic fluid resuscitation, blood of fluid in thoracic and abdominal
known as lauki, ghia or dudhi in India. p r e s s u r e wa s r e c o r d e d a s 1 4 0 / 1 0 0 cavities in mice. Cucurbitacin is a
In Ayurveda, bottle gourd is advocated mmHg. She was shifted to the ward, with strong signal transducer and activator
for treatment of diabetes mellitus, a diagnosis of bottle gourd poisoning of Transcription-3 (STAT3) inhibitor.
hypertension, flatulence, cooling with upper gastrointestinal bleeding Cucurbitacins not only inhibit the
properties, liver diseases, weight loss associated with severe dehydration. JAKSTAT pathway, but also affect
and other conditions. 1 It is part of Initial blood work up showed signs of other signalling pathways, such as
complementary and alternative therapy severe dehydration: hemoglobin 17.9 the MAPK pathway. 3 Though toxic
which is widely prevalent in India. 1 gm/dL, total leucocyte count 33200/ to animals, the bitter taste prevents
Though there are a few beneficial cumm, red blood cells 7.32/L, packed poisoning in humans. Higher levels
effects of bottle gourd extracts in cell volume 58.3%, SGOT 380 U/L, and of these cucurbitacins are triggered
animal models, human studies are few. SGPT 328 U/L, serum bilirubin 2.0mg/ by environmental stress, like wide
In recent times it has been unearthed dl,and renal profile and coagulation temperature swings low pH, high
that bottle gourd juice with a bitter taste profile were within normal limits. temperature, too little water, low soil
can cause severe toxic reactions and The patient underwent endoscopy fertility and improperly stored or
lead to symptoms such as abdominal which revealed pangastritis and severe overmature vegetables. 3
pain, vomiting, diarrhea, hematemesis, duodenitis (Figure 1). Ultrasonography There are a few reports of human
hematochezia, shock and death. 1 It is o f a b d o m e n wa s n o r m a l . S h e wa s toxicity due to cucurbits. In 1981–1982,
important for emergency physicians managed with intravenous fluids, in Australia and Alabama, and in 1984
to be aware of this toxicity especially antibiotics, antiemetics, proton pump in California, 202 cases of human
in India where bottle gourd juice inhibitors and discharged in a stable poisoning were reported by bitter
consumption is common place. condition after 5 days. Repeat blood test zucchini, a cucurbitaceae member. 1
was normal at the time of the discharge. One hour after ingesting bitter bottle
Case Report
gourd juice most patients can have
Discussion onset of symptoms such as vomiting,
A 36-year-old woman presented
to with complaints of severe upper We report a rare kind of poisoning diarrhea, upper gastrointestinal
abdominal pain, multiple episodes of that can occur in any population. bleeding and hypotension. 3 There is
vomiting and fresh blood in vomitus Bottle gourd (Lagenaria siceraria) no known antidote for this poisoning,
since morning. The episode had known as “Lauki” in northern India and management includes control of
begun after 2 hrs of she consumed is a member of the cucurbitaceae upper gastrointestinal bleeding and
200 ml bottle gourd juice in the family. It is cultivated throughout management of shock, for example,
morning. She presented with pulse the tropical and subtropical regions adequate isotonic fluid resuscitation
110/ minute, systolic BP 100 mm Hg, of the world for its unripe edible and blood transfusions if necessary.
respiratory rate 18/ minute, room air fruit as a vegetable. Other members Antibiotics are frequently administered
saturation 100%, temperature 98°F, of this family include cucumber, t o p r e ve n t a n d t r e a t s u p e r ve n i n g
and random sugar 100 mg/dL. She
h a d s e ve r e e p i g a s t r i c t e n d e r n e s s . 1
Consultant Gastroenterologist, 2Resident Gastroenterologist, Department of Medical Gastroenterology, Bombay Hospital and
No org anomeg aly was no t e d. The Institute of Medical Sciences, Mumbai, Maharashtra
rest of the systemic examination was Received: 06.01.2016; Accepted: 28.03.2016
unremarkable. The patient was given
88 Journal of The Association of Physicians of India ■ Vol. 64 ■ October 2016

References
1. Verma A, Jaiswal S, et al. Bottle gourd (Lagenaria siceraria)
juice poisoning. World J Emerg Med 2015; 6:308-10.
2. Sharma SK, Puri R, Jain A, Sharma MP, Sharma A, Bohra S, et
al. Assessment of effects on health due to consumption of
bitter bottle gourd (Lagenaria siceraria) juice. Indian J Med
Res 2012; 135:49–55.
3. Puri R, Sud R, Khaliq A, Kumar M, Jain S. Gastrointestinal
toxicity due to bitter bottle gourd (Lagenaria siceraria) –a
report of 15 cases. Indian J Gastroenterol 2011; 30:233–6.
4. Ghule BV, Ghanti MH, Saoji AN, Yeole PG. Antihyperlipidemic
effects of metabolite extract from Lagenaria siceraria
stand. Fruit in hyperlipidemic rats. J Ethnopharmacol 2009;
124:333–7.
Fig. 1: Upper gastrointestinal endoscopy showing patchy erythema in fundus, body and 5. Miro M. Cucurbitacins and their pharmacological effects.
antrum of stomach and first and second part of duodenum Phytother Res 1995; 9:159-68.

infections. uncommon clinical presentation

especially in countries like India, where
Conclusion the practice of traditional medicines is
widely prevalent.
It is important to be aware of this