Abrus precatorius poisoning.

Sir, This is with reference to Vaidya et al1 correspondence on the case report “Poisoning due to white seed variety of Abrus precatorius” by Pillay et al.2 Vaidya et al have noted that the use of broad spectrum antibiotics like meropenem and ceftriaxone by Pillay et al has no evidence based rationale. However, they themselves have mentioned the antidotal therapy for Abrus poisoning which has no evidence based rationale. They state that the eminent ayurvedic physician V.M. Gogte has mentioned in his textbook that the antidotes for Abrus precatorius poisoning are the juice of Amaranthus (Tandulja) and sugar. In our opinion, this data seems to have no evidence based rationale. Moreover, they themselves mention that the Amaranthus juice and sugar used as antidotes in the treatment of Abrus poisoning needs to be investigated in an experimental toxicity study. ‘Ellenhorn’s Medical Toxicology: Diagnosis and Treatment of Human Poisoning’, the classic treatise on clinical toxicology states that there is no antidote for treating Abrus poisoning.3 The mention of use of broad-spectrum antibiotics in the patient reported by Pillay et al suggests that the authors have disclosed all the facts in relation to the treatment of such a patient, and haven’t reported information needed only to the liking of the case report. We do agree with the reasoning provided by V.V. Pillay in this respect, in his ‘reply to the author’, that antibiotics were tried as an empiric measure before it could be conclusively established that the underlying cause for gastrointestinal clinical features was plant toxin related and not microbial in nature. Regarding the toxic profile in their case, Pillay et al wondered whether the white seed variety of Abrus precatorius had a different toxic profile as compared to the usual reported red seed variety of Abrus precatorius. The chemical constituents of both the white and red varieties of Abrus precatorius seeds are the same,4 and therefore, in our opinion there wouldn’t be any difference in their toxicity profile.