Don’t Let Your Heart “Go Nuts”- a Case Report of an Acute Aleurites-Moluccana (“Indian-Nut”) Pediatric Intoxication

Background: The Aleurites-moluccana seed, also known as “Indian-nut”, is illegally promoted worldwide as a nutritional supplement for weight loss. While the manufacturer advises a daily consumption of a quarter of a seed, there are no controlled trials to assess neither its efficiency and side effects nor the proper dose. The seed was previously reported as causing vomiting and diarrhea, as well as alternating heart rate in a few case reports in adults. This case report is the first documentation of pediatric “Indian-nut” seed intoxication.

Case presentation: A 3-year-old girl presented to our hospital with excessive vomiting and diarrhea, 24 hours after accidental ingestion of “Indian-nut” supplement. She had normal vital signs on admission but later developed self-resolving bradycardia episodes (down to 58 beats-per-minute). She appeared ill, pale and lethargic, with Glasgow-coma-scale of 14 and moderate dehydration signs. Intravenous fluid resuscitation was given and later blood tests revealed hyperkalemia and ECG showed first degree atrioventricular (AV) block which subsequently progressed to second degree AV block. A diagnosis of cardiac glycoside poisoning was suggested and a following digoxin immunoassay was positive. Digoxin-specific-antibody treatment (Digifab) was given with resolution of the AV block within an hour. All symptoms resolved within 3 days.

Discussion: Since literature regarding cardiotoxicity from “Indian-nut” is scarce, this case report emphasizes a dangerous cardiac side-effect of this herbal weight loss product, probably due to adulteration by a cardiac glycoside containing substance. Physicians should remain vigilant for possible cardiotoxicity associated with the use of dietary supplements, especially pediatric accidental ingestions.