Authors: Suresh Kumar Neeraj Kumar
Publish Date: 2014/02/14
Volume: 81, Issue: 9, Pages: 955-955
Abstract
To the Editor Neem oil Margosa oil is deep yellow extract of neem tree Azadirachta indica A Juss seeds widely used in India as a traditional medicine for various skin diseases as pesticide/insecticide and in cosmetics 1 2 Toxic ingredients include azadirachta nimbin nimbinin nimbidin nimbidol picrin and sialin 1 2 Poisoning is usually accidental by nasal or oral administered to infants and children for cough and cold pain abdomen and deworming or rarely suicidal 2 Even small doses can cause toxicity include vomiting drowsiness generalized seizures coma and severe metabolic acidosis especially in infants and young children 3 Management is usually supportive in form of control of airway breathing and circulation avoid gastric lavage control of convulsions and correction of metabolic acidosis with intravenous fluids oxygen and sodium bicarbonate 1 2We report a 3moold boy who presented with unconsciousness soon after his mother gave him 5 mL of neem oil orally for supposed indigestion He had tachycardia tachypnea normal blood pressure perfusion oxygen saturation Glasgow coma score GCS of E3V3M4 and normal rest of neurological and systemic examination He had metabolic acidosis pH 721 bicarbonate 14 and base deficit 10 and normal blood counts blood sugar Creactive protein renal and liver functions electrocardiogram and chest radiograph He was started on oxygen intravenous fluids and Ceftriaxone He was not subjected to lumber puncture and neuroimaging and antibiotics were stopped as coma and metabolic acidosis started improving and normalized between 1824 h and literature suggests that these are features of Neem oil poisoning He was discharged after 48 h and was well 3 mo after dischargeFew infants and children have been reported with similar features after Neem oil poisoning 1 2 3 4 5 Prognosis is usually good however delayed milestones long term neurodeficits recurrent seizures abnormal electroencephalogram EEG and deaths have been observed 2 5 Since neem oil is commonly used as traditional medicine in India its poisoning is not uncommon So pediatricians should be aware of this condition and public should be educated regarding the safe use of neem oil
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