Depression is the most layman term that has become quite common over a while among teenagers and young adults especially during the starting of the pandemic phase. It is the most dangerous form of mental sickness which, if not treated properly ends up in suicidal thoughts or self-ingested death.
The increasing cases of depression must be treated with proper consultation from a psychologist. But what is more alarming is that when people undergo these depression episodes, repercussions that follow which are most probably suicidal thoughts are highly increasing due to the easy availability of toxic substances like dangerous drugs and poisons. One such plant poison is Cerbera Odollam (ping pong).
How the Richest Plant is a Toxic Poison?
Cerbera odollam, also known as ping pong plant or suicide tree is mostly found in Southern India, Southeast Asia, Madagascar, and Australia. It appears oval to round in shape, resembling raw passion fruits. Their seeds are the ones used as a potential poison that contains the heaviest poisonous chemical termed Cerebrin. When ingested it increases the potassium content of blood, disrupting the cardiac electrical activity inhibiting sodium-potassium exchange in myocardial cells. In short, it leads to a cardiac arrest or heart attack.
Cereberin is a type of cardiac glycoside, a steroidal class found in the seeds of the dicotyledonous angiosperm genus Cerbera. This class includes digitalis-like agents, channel-blockers that as a group has found historic uses as cardiac treatments, which at higher doses are extremely toxic.
Cerberin, as a cardiac glycoside, is seen as binding and inhibiting the cellular Na+/K+ ATPase, because it binds to the alpha-subunit of the enzyme. This is the catalytic moiety. There are also beta- and FXYD subunits. These two subunits influence the affinity of cerberin to Na+/K+ ATPase.
This dicotyledonous angiosperm belongs to the family Apocynaceae and it produces a milky white latex over its fruits. They also contain flowers ranging from white-light peach color. They grow preferentially in salty swamps and marsh areas.
In South India, they are mostly found in Kerala and Tamil Nadu. The fruit contains a mesh-like structure inside, around its seed, due to which it has an alternating density. When these fruits fall from the tree to water bodies, they don’t sink instead they float. As a result of which they form sediments and grow in huge quantities around these marsh areas.
When a death is reported of suspected poisoning, forensic toxicological analysis of the viscera is done. Different methodological analysis ranging from regular chromatography to high wavelength spectroscopies are preferred for toxicological analysis of substrates in cases of suicides or homicides using poison.
Of the reported Cerbera Odollam cases, IR spectroscopy was mostly used in the analysis of viscera. Chromatography too can be accepted as a reliable, speedy, and cost-effective procedure if TLC plates are large and the solvent is allowed to run sufficiently long.
Specimens given for toxicological testing are usually collected by the forensic pathologist (who may also be an appointed “medical examiner” or “coroner” in some jurisdictions) or mortuary technician during an autopsy. Specimens must be properly identified, labeled, and sealed as soon as practicable after collection.
All specimens about a case must be collected and bagged separately in tamper-proof containers. Unique numbered seals are used to track all evidence for each case. Like any other evidence, the chain of custody must be preserved at all times, from the mortuary through the laboratory testing, reporting, and storage, for court purposes. The sample collected usually other than the viscera include, blood, urine, etc.
The reported symptoms of Odollam toxicity include headache, muscle weakness, dizziness, altered mental status, nausea, vomiting, abdominal pain, chest pain, and palpations. Bradycardia, hyperkalemia, and thrombocytopenia are often present. A wide variety of ECG findings are reported and consist of sinus bradycardia, sinus pauses, junctional rhythm, prominent U-waves, wandering pacemaker, atrial fibrillation, ventricular tachycardia, digoxin-like ST changes, nodal rhythm, and first-, second-, and third-degree heart block.
Death by poison can happen in a variety of ways, for example through recreational exposure by inhaling solvents, or consuming the poison as it is in case of suicidal trajectories. Ping pong is usually taken in for suicide and even if it is in case of suspected homicidal poisoning the mode of consuming is generally the seeds, where they are crushed and mixed with normal food (can be fluid or solid).
Case of Attempted Suicide
Around the year 2000, a transgender female from Tamil Nadu was admitted to the hospital on a reported case of a suicide attempt. She was 32 years old and had a past medical history of depression and suicidal ideation. It was found that she had purchased seeds of Cerbera Odollam online, a week before the incident and was found to have ingested one seed of the fruit known to be the lethal dose.
While she was transported to the hospital, her heart rate was documented to be 30 with a junctional rhythm, hence she was administered with a total of 10 vials of Digiband (digoxin immune fab).
When asked for common symptoms she refused to have experienced headache, visual disturbances, palpitations, diarrhea, or constipation. Her body fluids mainly urine was sent for toxicological analysis and it was found to be positive for cannabis and cereberin. Also, her potassium level was found to be 4.3 mmol/L.
Her electrocardiograph demonstrated a significant decrease in heart rate as compared to presenting vital signs. She also had a hypoglycemic episode with a blood glucose of 60 mg/dL.
After this, she was under observation and the following day psychiatry team was called in and she was diagnosed with Gender Dysphoria and Depressive disorder. Once she was stabilized, she was moved into the Psychiatry unit.
Humans are identified as the most intelligent species. For ages, they were the best when it comes to innovation and technology. Even in the Agricultural field, pesticides were found to be one of the most innovative outcomes men have come up with for crops.
But just like any other chemical, the pesticide was used as a suicide agent too. Especially it was used by the men of the land- The farmers. This is a classic example of the misuse of inventions. It is extremely easy nowadays to access dangerous poisons, be it pesticides or seeds of Cerbera Odollam or even venom of snakes.
At the same time, there is a high need for improvement in psychological education in India. It is necessary to give mental support to people who are struggling.