Niyangala (Gloriosa Superba) Poisoning Complicated with SIADH

Background: Niyangala poisoning used to be a common method of deliberate self-harm among people living in rural areas of Sri lanka. It is a plant that grows in the wild and has no usage. All parts of this plant are poisonous.The toxic ingredient in Niyangala is Colchicine. Even though Colchicine poisoning is uncommon, it can lead to life threatening complications and be considered a toxicological emergency. It can cause severe gastroenteritis, abdominal pain, hypotension, electrolyte imbalance in the initial phase, as well as granulocytopenia, thrombocytopenia, clotting defects, hepatic insufficiency and renal failure after the first 24 hours. Case presentation: A 62-year-old male presented to our medical unit with several episodes of severe watery diarrhea 6 hours after the ingestion of 3 tubers of Niyangala. He also had epigastric pain, nausea and vomiting. He had eaten Niyangala after consuming alcohol and claimed it was after a dispute with his wife. On admission, the patient was in pain with some dehydration but he was afebrile. Discussion: SIADH consists of hyponatremia, inappropriately elevated urine osmolality (>100 mOsm/kg), and decreased serum osmolality in a euvolaemic patient. SIADH should be diagnosed when these findings occur in the setting of otherwise normal cardiac, renal, adrenal, hepatic, and thyroid function; in the absence of diuretic therapy; and in the absence of other factors known to stimulate ADH secretion, such as hypotension, severe pain, nausea, and stress. Conclusion: SIADH is a well-recognized complication of colchicine poisoning. We report for the first time SIADH after the ingestion of tubers of Gloriosa superba. Hyponatremia in a patient after poisoning with Gloriosa superba is usually attributed to severe diarrhea which is a common and dominant clinical feature often managed with fluid replacement.