Nut poisoning

Nuts are a healthy and nutritious product that contains many vitamins and minerals. It is known that even a small handful of them can saturate the body and give an influx of energy, since the composition contains not only healthy fats, but also a unique plant sterol, proteins and fibers. But we must not forget that nut poisoning can also happen - for example, when they are overeating, improper storage or for other reasons. Why and how you can poison with nuts, and what to do to avoid this?

Epidemiology

There are no clear statistics on the frequency and number of nut poisoning in the world. It is only known that such intoxications are relatively rare: no more than 5% among all food poisoning. But the most common cause of the disorder is overeating. However, people do not always go to the doctor with this problem, preferring to “lie down” at home. 

Experts warn: self-medication is dangerous, especially with severe forms of poisoning. Therefore, it is better to consult doctors, even if in order to prevent complications.

Causes of the nut poisoning

The causes of nut poisoning are different. According to statistics, most often the problem is associated with such factors:

• overeating, eating a large amount of nuts at a time;
• eating some raw nuts that can only be eaten by heat;
• the use of spoiled nuts that have been stored incorrectly or for too long;
• the use of nuts treated with chemicals for better preservation or presentation.

Often the reason is banal non-compliance with hygiene rules (unwashed hands), or an incorrect combination of products (for example, nuts cannot be combined with milk).

Most nuts must be fried before eating, and not just to improve their taste. A raw product can become a source of dangerous infectious diseases due to the content of pathogenic microorganisms in it - most often such "nut" poisoning is caused by Escherichia coli and Salmonella. Microbial contamination of the raw product occurs during harvesting, and all the necessary conditions for the further development of the infection can be created if stored improperly - for example, in a too humid room, in moist, non-ventilated cellars, etc.

Some raw nuts are dangerous in themselves. For example, on the cashew shell without heat treatment, there is a toxic component cordol. Upon contact with the mucous tissue, the cordol causes a burn-like reaction. [1] And raw bitter almond kernels contain amygdalin glycoside, which together with another nutty substance emulsin become sources of hydrocyanic acid - a potent toxic agent. [2]

Risk factors

Of course, nut poisoning can happen to each of us. However, there are some categories of patients prone to intoxications and complications more than others:

• Pregnant women.

During pregnancy, the female body completely rebuilds metabolic processes and the circulatory system. In addition, it is sometimes very difficult for women to cope with food addictions - for example, if you want nuts, then a handful is not enough. As a result, there is overeating and, as a result, poisoning by nuts.

• Old men.

In old age, the human digestive and immune systems work much worse and slower than in youth. Therefore, it is more difficult for an old man to cope with intoxication than a young body.

• Children.

In children under 3 years old, nuts are generally contraindicated. They can be given little by little (literally 1-2 pcs.), Starting from 4-5 years of age. This product is difficult to digest with the children's digestive system and can cause unpredictable pathological reactions - in particular, allergies or intoxication.

• Patients suffering from chronic diseases of the liver, kidneys, digestive system and endocrine system.

Pathogenesis

Nuts are a tasty, nutritious, but at the same time difficult product for digestion, therefore, they can disrupt the process of digesting food, the production of enzymes, or cause an allergic process, which often takes the form of poisoning. [3] In addition, other pathogenetic causes of intoxication are distinguished:

• mold and fungal flora of mycotoxin may be in the shell and near the shell (it is very difficult to notice it at an early stage of development);
• nuts were collected in ecologically unfavorable areas, near cultivated fields or freeways;
• nuts were improperly roasted, stored under unacceptable conditions, or were further processed with chemicals.

Even if all pathogenetic factors are present, some people have nut poisoning, while others do not. It depends both on the general state of a person’s health and on the quality of his immunity, on the individual characteristics of the body, and on dietary preferences.

Symptoms of the nut poisoning

In most patients, nut poisoning is due to overeating. The clinical picture has much in common with conventional food poisoning or with non-diabetic ketoacidosis.

The first signs appear, regardless of the species of nuts: [4]

• dull soreness in the stomach and intestines;
• violation of digestion, diarrhea and constipation;
• nausea with bouts of vomiting;
• irritation of the oral mucosa;
• general weakness, lethargy, loss of strength;
• dizziness, confusion.

In case of nutmeg poisoning, characteristic signs similar to alcoholic or marijuana intoxication are observed. Patients complain of a sensation of pain and compression in the temporo-occipital zone, difficulty in thinking, and apathy. With severe poisoning, the victim must be hospitalized. [5]

With walnut overeating, there are signs of a malfunction on the part of the pancreas:

• pain under the ribs on the right;
• discomfort in the stomach;
• bloating, belching, nausea;
• vomiting with bile, bitter taste in the oral cavity.

When poisoning with a poor-quality and moldy product, patients note the appearance of frequent loose stools, abdominal pain, loss of appetite, thirst, trembling and weakness in the arms and legs. Painful symptoms increase within a few hours after a meal.

Forms

[7], [6]

Brazil nut poisoning in most cases is due to the fact that this exotic product is a strong provocateur of allergic reactions. In addition, it contains a toxic carcinogen - aflatoxin, which is present in the walnut skin, but if stored improperly, it enters the nucleus. When ingested, aflatoxin negatively affects the structure of the liver and kidneys. If you regale with a Brazil nut too often, then the risk of diseases from the nervous and respiratory systems also increases. 

Hazelnut poisoning does not happen often. However, if you eat more than 60 g, it is easy to overload the digestive tract: digestion is disrupted, various hypersensitive reactions may occur in the form of a rash on the body, itching and redness of the skin. Some people have severe headaches like migraine attacks. Often there is an increase in bile secretion, which immediately affects the work of the intestine.

Hazelnut poisoning is caused by the use of a large amount of raw product, which greatly complicates the digestive tract, inhibits intestinal motility, leads to stagnation of bile, causes pain in the pancreas. Even roasted nuts amid overeating can cause the development of arthritis, arthrosis, gout. Excessive consumption of nuts in childhood is especially dangerous.

Complications and consequences

The vast majority of cases of nut poisoning end positively for the patient. For example, nut overeating most often takes place on its own, subject to a restrictive diet.

Complications from nutmeg poisoning are dangerous, since it contains the psychotropic component myristicin, which impairs the transmission of nerve impulses, and has a hallucinogenic effect. Muscat intoxication can result in cramping and convulsions, dehydration and death. An epileptic seizure occurs after eating 5.6 g of walnut. [8], [9]

Raw cashew nuts, due to its allergotoxin urushiol content (it is also found in ivy venom), causes burns on contact with it.

Other adverse effects may include:

• pneumonia;
• pyelonephritis, renal failure;
• hepatitis, liver failure;
• respiratory muscle paralysis;
• acute heart failure.

Some complications are fatal.

Diagnostics of the nut poisoning

Before making the correct diagnosis, the doctor will need to collect detailed history data. Therefore, it performs the following actions:

• interviews the victim;
• measures the temperature (if necessary, and blood pressure), palpates and evaluates the pulse;
• examines the body for an allergic reaction, probes the abdomen, examines the mucous membranes of the oral cavity.

Next, tests are prescribed that should be passed in the laboratory:

• general blood analysis;
• fecal analysis (coprogram).

Other laboratory tests may be prescribed at the discretion of the doctor:

• Analysis of urine;
• study of vomit, etc.

Instrumental diagnostics are rarely used, depending on the indications:

• fibroesophagoscopy, gastroduodenoscopy;
• colonoscopy;
• sigmoidoscopy;
• X-ray examination.

If several people were poisoned at once, then representatives of the sanitary-epidemiological service additionally examine the products that caused intoxication.

Differential diagnosis

Differential diagnosis is carried out with other types of intoxications, with acute appendicitis, pancreatitis, diseases of the hepatobiliary system.

Treatment of the nut poisoning

If nut poisoning is suspected, the stomach should be washed as soon as possible  . To do this, use a weak soda solution, or very weak potassium permanganate. After washing, they drink any sorbent drug and consume a lot of liquid.

Medicines are prescribed by the doctor if necessary.

A mandatory part of the treatment of nut poisoning is considered a diet. On the first day or two, it is advisable to completely exclude food intake. At least, you should definitely abandon fatty, spicy, heavy dishes, dairy products, alcoholic beverages.

Further, the food should be organized in small portions: eat dishes boiled or cooked in a double boiler. It is necessary to drink a lot, gradually restoring impaired body functions.

To accelerate recovery, you must adhere to such recommendations:

• in the acute period of nut poisoning, the patient should observe bed rest, drink a lot (both water and green tea, rosehip or chamomile color infusions are perfect);
• on the second day, when the symptoms of poisoning subsided, you can gradually eat shabby boiled food, but in very small quantities;
• in the next few days, the diet is gradually expanded, but they continue to drink plenty of water, avoid the use of fatty and spicy foods.

Medications Your Doctor May Prescribe

To accelerate the elimination of toxic substances from the digestive system, sorbents are used - for example, Enterosgel, Polysorb, activated carbon. Such drugs minimize the flow of toxins from the digestive system into the bloodstream, promote the excretion of alkaloids, salts of heavy metals, etc. From the body. [10]

Enterosgel is taken in the amount of 1 tbsp. L with water, three times a day. Activated carbon is prescribed at the rate of 1 tab. Per 10 kg of the victim’s weight. Tablets of "white coal" take 2-3 pcs. Three times a day, until normalization of health. Side effects of this treatment may be thirst, constipation.

After cleansing the digestive tract, it is important to take measures to replenish the fluid lost by the body.  Most often, experts advise drinking ordinary boiled water, weak tea, infusion of chamomile or rose hips. You can also use special pharmacy products:

• Regidron - prepare a solution based on one sachet of the drug and one liter of water, drink it during the day. The duration of treatment is 3-4 days.
• Oralit - one sachet of the drug is diluted in 200 ml of water, taken after each case of loose stool.
• Ionika - taken by analogy with Oralit. It is extremely rare during the administration of oral rehydrants that an allergic reaction occurs, other side effects are not detected.

If restoration of the intestinal flora and functionality of the pancreas is required, then one of these drugs is additionally prescribed:

• Hilak forte - oral drops that are taken with food about 40-60 drops at a time, three times a day. Possible side effects: allergy, uncomfortable feeling in the abdomen.
• Linex is a combined drug, it is prescribed 2 capsules three times a day with food. Side effects in the form of allergies are found only in isolated cases.
• Festal is an enzyme that improves digestion. Take it one tablet with water, after the main meal. Long-term use of the drug is possible. Adverse events are rare and are usually associated with the underlying disease.
• Mezim is a multienzyme preparation that is prescribed for 1-2 tablets before each meal. Treatment can be long, side effects are rare.

Taking painkillers, anti-inflammatory drugs and antibiotics is possible only with the appointment of a doctor. So, in some cases, sulfonamide drugs (Phthalazole, Biseptol), antibiotics (Levomycetin), non-steroidal anti-inflammatory drugs (Ibuprofen, Paracetamol) may be indicated.

Prevention

To avoid nut poisoning, you need to follow a few simple rules:

• Before any meal, always wash your hands, eat from clean dishes;
• never overeat nuts, it is enough to eat a small handful - that is, no more than 50 g per day;
• avoid raw nuts, especially if you are not sure about their quality and storage conditions;
• never combine nuts with dairy products, fatty and high-calorie foods;
• poisoning with nuts cannot be avoided if spoiled, unpleasantly smelling, moldy specimens go into food.
• Be sure to consult a doctor if:
• there were pains and pains in the abdomen, dizziness, pain in the head, rash, fever;
• heaviness in the abdomen does not go away the next day;
• more than one day there is vomiting, diarrhea;
• signs of poisoning are present in the child or the old man.

Forecast

Fortunately, in most patients, nut poisoning is completed without any negative consequences for the body. In particular, signs of nutritious overeating pass without a trace already on the third or fourth day. But with prolonged eating of raw almond kernels, liver and pancreas diseases can develop. In severe cases, the patient is found to have hepatitis, pyelonephritis, and muscat poisoning can even result in respiratory muscle paralysis or acute heart failure.