Tomato poisoning

Everyone knows that vegetables are extremely healthy, including tomatoes. Juicy tomatoes often appear on our tables: in the summer - fresh, and in the winter - in the form of home preservation. However, few people know that tomato poisoning is a fairly common phenomenon that occurs as a common food intoxication. And any person should know all the signs of pathology, the basics of first aid and preventive measures when eating these vegetables. [1]

Epidemiology

Statistics show that as a result of the use of low-quality products in the world every tenth person falls ill every year, and more than 400 thousand of them die.

The increased risk is observed in children under five years of age: about 125 thousand pediatric patients die from food intoxication every year. The highest incidence is recorded in the countries of Africa and Southeast Asia. [2]

Up to 30% of all deaths from food poisoning occur among children under 5 years of age, although this category of patients accounts for only 9% of the total population of the planet. The causes of intoxication are most often bacteria, viruses, parasites, toxic and chemical substances. 

Poisoning risks are particularly high in low- and middle-income regions and are associated with unsafe cooking water, inadequate hygiene and improper cooking and storage conditions, lack of food safety criteria, or inadequate quality control.

A special count of the number of poisonings specifically with tomatoes was not carried out.

Causes of the tomato pickling

Tomato poisoning does not always occur, but only for certain reasons. In general, tomatoes are safe to eat if properly grown, canned, stored under normal conditions, etc.

Why do people sometimes get poisoned?

• Vegetables that are treated with various chemicals to improve / speed up growing, eliminate insect pests and optimize storage can pose a risk to human health. Some reagents are absorbed by tomatoes, and then enter our body after they are consumed. Ingestion of toxins in large quantities causes severe poisoning.
• Bacteria enter the digestive tract if the tomatoes are not washed before eating, preferably in running water.
• Even if you eat well-washed tomatoes with dirty hands, you can get an intestinal infection. Therefore, it is extremely important to wash your hands before preparing food and before eating.
• Rotten and spoiled fruits are very dangerous, since putrefactive processes are accompanied by the development and reproduction of various pathogenic microorganisms. Even if you cut off the damaged area, mold spores can remain on the apparently healthy part of the tomato, and in the future cause the development of poisoning. Spoiled fruit should be thrown away without regret.
• Unripe tomatoes can cause poisoning if eaten raw in large quantities. This is due to the content of solanine, tomato and lycopene in green fruits. A single use of already 5-6 untreated tomatoes can cause quite severe intoxication.
• Canned vegetables can be poisoned if the rules of conservation and pasteurization were not properly followed during their preparation. For example, poisoning cannot be avoided if the tomatoes were poorly washed, damaged, or there were violations of the rules for storing canned food.

Even those vegetables that have been grown and processed with all the necessary conditions can be harmful. For example, if a person has an individual hypersensitivity to nightshades, then he should generally delete tomatoes from the diet, regardless of their type and cooking option. [3]

Risk factors

It is difficult to completely protect yourself from tomato poisoning. However, you can minimize certain factors that increase the risk of intoxication - for example, observe hygiene rules, use only washed and processed foods, etc.

There are certain groups of people who are most at risk of poisoning:

• Women during pregnancy. During gestation, changes in the circulatory system and metabolic processes occur in the female body, immunity is weakened, which can increase the risk of intoxication.
• Old men. Over the years, the immune defense weakens, many chronic diseases appear, which increases the body's susceptibility to toxic substances.
• Children under 3-5 years old. The children's body often cannot withstand toxic agents, which is associated with the still imperfect development of the immune and digestive systems.

Also at risk are patients suffering from diabetes mellitus, chronic digestive pathologies, metabolic disorders, as well as people with immunodeficiency.

Pathogenesis

If tomatoes were grown and stored correctly, reached their maturity and were adequately cooked in compliance with sanitary and hygienic recommendations, then it is almost impossible to get poisoned by them. If at any stage there was a violation, then the likelihood of intoxication is not excluded. Why could this happen?

An unfavorable effect on the composition of vegetables occurs if the fields are in close proximity to large main roads, chemical plants, landfills, sedimentation tanks, etc. Harmful substances that penetrate the fruits, with their further use, can cause severe poisoning. In addition to the unfavorable environmental situation, a negative impact is noted during the processing of fields and crops with chemical fertilizers, pest and weed control agents.

When eating unripe, and especially dark green fruits, severe intoxication with damage to the nervous system can occur, which is due to the presence of toxic substances hazardous to health in such tomatoes - primarily solanine.

Solanine is a glucoalkaloid found in frequent green nightshade plants (including tomatoes, potatoes, eggplants). In tomatoes and eggplants, the concentration of this substance varies depending on the ripeness of the fruit, and for potatoes, the conditions and duration of storage of tubers are important. If the presence of solanine in a vegetable exceeds 20 mg / 100 g, then the likelihood of developing poisoning increases significantly. [4]

However, according to statistics, the largest number of poisonings is associated not with the presence of solanine, but with the use of unwashed vegetables. During the collection, transportation, storage of tomatoes, bacteria, viruses, fungi accumulate on their surface, which later become the cause of poisoning.

Symptoms of the tomato pickling

The first signs of tomato poisoning are detected within 1-2 hours (sometimes even 24-48 hours) after a toxic or infectious agent enters the body. The severity and variety of the clinical picture depends on the type of intoxication, its cause, as well as on the general health and age of the patient.

The main signs of tomato intoxication are:

• deterioration in general health, weakness, loss of appetite, dizziness;
• diarrhea;
• temperature increase;
• abdominal pain (persistent or crampy);
• nausea, often with vomiting;
• increased gas formation;
• headache, changes in blood pressure.

With severe poisoning with neurotoxic substances, the following symptoms can be observed:

• severe dizziness, delirium, hallucinations;
• numbness of the limbs, trembling in the fingers;
• dehydration (increased breathing and heart rate, dry mouth);
• clouding of consciousness;
• drop in muscle tone.

These symptoms are characteristic of an infection such as botulism, a dangerous condition that requires urgent medical attention. [5]

The severity of the clinical picture is directly dependent on the number of consumed tomatoes. If the patient ate a little low-quality vegetables, then the symptoms recede relatively quickly, and if a lot, it intensifies and becomes more complicated. [6]

With severe poisoning, certain symptoms may be present during the recovery stage. For a long time after intoxication, many patients continue to worry about:

• general weakness, asthenia;
• vegetative-vascular reactions, sweating, unstable hemodynamics;
• hypersensitivity of the digestive tract to raw vegetables and fruits, dairy products;
• increased gas formation, instability of the stool.

Such symptoms indicate a decrease in the adaptive capabilities of the gastrointestinal tract and can lead to the development of chronic diseases of the digestive system. [7]

Poisoning with green tomatoes

Tomatoes are eaten not only red, but also green - unripe. Such fruits have a specific taste that many people like. However, unripe tomatoes also contain toxic components, one of which is the well-known solanine, which in high doses can cause severe poisoning.

Solanine is a toxic glycoalkaloid that provides natural protection for the fruit from mold. In the process of ripening vegetables, the content of this poison decreases, therefore, the lighter and redder the fruit, the safer it is. It is worth noting that in low concentrations, solanine is even useful: it strengthens the cardiovascular system, has antiviral activity. However, if you eat 5-6 rich green tomatoes, then poisoning is almost guaranteed. [8]

In addition to solanine, green tomatoes also contain components such as lycopene and tomato:

• Lycopene is a strong antioxidant that can prevent DNA mutations and the development of cancer, prevent lens pathology and atherosclerosis. But an overdose of this substance is dangerous in terms of poisoning. [9]
• Tomatin - an active antioxidant and immunomodulator, is the base of the famous cortisone medication. Excessive consumption of tomato can cause serious poisoning.

Experts explain: in order for an adult to be able to benefit from unripe tomatoes and not get poisoned, you should choose fruits of a light green color and eat them in an amount not exceeding 300 g per day. Children should not be given green tomatoes. During heat treatment, the concentration of hazardous substances in vegetables is significantly reduced.

Poisoning with fresh tomatoes

Tomatoes, like many other vegetables, are susceptible to a large number of diseases: fungal, microbial, viral, as well as damage by insect pests, etc. Many diseases arise from improper or insufficient feeding of plants during growth, deficiency or excess watering.

Diseased plants - for example, when apical rot appears - are not recommended to be eaten. Even if the brown lesion is carefully cut away, the infection can remain on the seemingly healthy parts of the vegetable. If you eat such a tomato, then a person may develop digestive disorders, the intestinal microflora is disturbed.

Poisoning can be obtained even if you eat tomatoes that were lying near a rotten specimen without first washing them. Thoroughly washing vegetables and fruits just before eating is an important rule for the prevention of intoxication and digestive disorders.

Poisoning with canned tomatoes

In the winter season, tomatoes are consumed mainly in canned form. It can be pickled and pickled tomatoes, tomato salads, lecho, adjika, ketchup, etc. Housewives know many recipes for such preservation, which can be stored for a long time without losing taste. However, in some cases, such blanks can be poisoned. The reasons may be as follows:

• insufficiently washed and poorly sterilized containers for conservation;
• the use of broken, rotten, spoiled tomatoes, poorly washed greens;
• improper preparation of the brine;
• the use of insufficiently tight, leaky covers;
• storage in unsuitable conditions, or too long storage of an already opened can.

The first signs that a product is a poisoning hazard are:

• swelling of the lid;
• cloudy liquid in the jar;
• the appearance of signs of fermentation (foam, gas formation).

Spoiled canned tomatoes should not be eaten; they should be thrown away.

Poisoning with cucumbers and tomatoes

Toxic components in vegetables are most often represented by nitrates - salts of nitric acid, which enter the fruits from the soil along with fertilizers. If there is not enough nitrogen in the soil, then a normal crop cannot be obtained, because this mineral is responsible for the formation of plant stems and leaves.

However, if top dressing is not applied to the soil on time, or in the wrong dosage, then the nitrate content in vegetables will exceed the safe concentration.

Nitrate poisoning with cucumbers and tomatoes is manifested by the following symptoms:

• severe fatigue, headache;
• dizziness;
• pain in the abdomen, heart;
• darkening in the eyes;
• digestive disorders.

Poisoning occurs when the threshold of a safe daily dose is exceeded, which for an adult is 3.7 mg / kg of body weight, and for a child - 0.2 mg / kg of weight. That is, if vegetables contain a large amount of nitrates, and a person has eaten a lot of fruits, then the risk of intoxication increases significantly. Usually tomatoes contain a relatively low concentration of a toxic compound - about 80-100 mg / kg of the product (for comparison: watermelons, melons, beets can accumulate up to 5 thousand mg of nitrogen salts).

Complications and consequences

Complications against the background of tomato poisoning develop relatively rarely - mainly in patients with concomitant chronic pathologies, as well as in elderly patients, children, people with weak immunity.

Possible complications include:

• dehydration up to the development of hypovolemic shock (a condition caused by a decrease in the volume of circulating blood due to a rapid loss of fluid);
• acute heart failure, arrhythmia;
• infectious toxic shock, which is accompanied by fever, impaired consciousness, etc.
• deaths of solanine poisoning have been described. [10]

Among the rarest complications provoked directly by the pathogenic agent during the spread of infection, appendicitis, cholecystitis, pancreatitis, etc., as well as generalized infection with persistent bacteremia, can be distinguished. Such complications are characteristic mainly for the height of pathology, as a result of which their signs are sometimes masked by the picture of the poisoning itself.

Diagnostics of the tomato pickling

It is not difficult to suspect tomato poisoning. There is a history of the use of a low-quality or suspicious fruit, after which, after a few hours, the following signs were found:

• dyspepsia (nausea, vomiting, diarrhea, bloating);
• pain in the stomach, intestines;
• general intoxication (weakness, fever, heart palpitations, pale skin, cold sweat).
• Analyzes may include:
• bacteriological examination of vomit, feces, food debris;
• general analysis of blood, urine;
• biochemical blood test, coagulation study.

Instrumental diagnostics is necessary to assess the degree of damage to internal organs and systems. Perhaps the appointment of such diagnostic procedures as ultrasound, electrocardiography, radiography, colonoscopy, gastroduodenoscopy, magnetic resonance imaging or computed tomography.

Differential diagnosis

Very often, for the correct diagnosis, it is necessary to involve specialists from different medical fields for consultation - in particular, a gastroenterologist, a neuropathologist, a surgeon. This is necessary for the differential diagnosis of poisoning from other pathologies with similar symptoms:

• acute attack of appendicitis ;
• meningitis, acute or transient circulatory disorders in the brain, subarachnoid hemorrhage;
• inflammatory process in the pancreas ( pancreatitis );
• inflammatory process in the gallbladder (cholecystitis);
• gastritis;
• myocardial infarction with abdominal manifestations, less often - hypertensive crisis;
• in women - ectopic pregnancy , pregnancy toxicosis, torsion of the ovarian cyst, pelvioperitonitis.

Tomato poisoning should also be differentiated from botulism , mushroom poisoning, heavy metal salts and organochlorine compounds. [11]

After differentiation and clarification of the causes of the poisoning, the doctor prescribes a treatment that is suitable for a specific pathological situation.

Treatment of the tomato pickling

Therapeutic procedures for tomato poisoning most often consist in the following stages:

• first aid;
• further treatment at home or see a doctor.

When to see a doctor:

• with indomitable vomiting, severe weakness caused by the increasing dehydration of the body;
• when it comes to a child;
• if there is an increase in temperature, convulsions;
• if the condition worsens, bloody vomiting appears, yellowing of the sclera, problems with breathing or swallowing;
• if light-headedness or fainting develops.

First aid consists of the following measures:

1. Gastric lavage. The patient should drink 2-4 glasses of water, then press on the base of the tongue and induce a gag reflex. Washing is carried out until clear water comes out without inclusions.
2. Purgation. If there is diarrhea, then you do not need to stop it, as it promotes natural bowel cleansing. If there is no emptying, then several cleansing enemas can be given.
3. Reception of sorbents. After the completion of the previous procedures, the patient is given any sorbent preparation to drink. Perfectly suited: white or activated carbon, Enterosgel, Atoxil, etc.
4. Replenishment of fluid levels in the body. Drink plenty of fluids. You can use clean warm water, green tea, infusion of chamomile, mint, calendula, Regidron and other similar solutions.

On the recommendation of the attending doctor, symptomatic treatment is prescribed. In some cases, it becomes necessary to conduct antibiotic therapy: drugs are selected, depending on the type of infection. [12]

In addition, it is possible to use:

• antispasmodics, analgesics;
• enzyme preparations;
• remedies for bloating and gas production;
• means that improve the quality of intestinal microflora.

If the patient has severe vomiting, and the condition threatens the development of dehydration and complications, then the doctor may prescribe antiemetics.

The nutrition of patients who have received tomato poisoning should be severely limited, with an orientation to the  treatment table No. 4 . On the first day, it is recommended to completely abstain from eating. As the condition normalizes, slimy soups, rice porridge, vegetable broths, mashed meat and fish, omelet, vegetable puree, fresh cottage cheese, jelly, dry bread and biscuit biscuits are introduced into the diet. For several days, exclude milk, raw vegetables and fruits, canned food, sausages, smoked meats, spices. It is recommended to follow a gentle diet for 2-4 weeks (depending on the degree of poisoning). [13]

Medicines

We suggest that you familiarize yourself with a number of medicines that are most often used for tomato poisoning in adult patients.

• Activated carbon - available in black tablets, available without a prescription. Belongs to the category of non-selective sorbents. The usual dosage is 5-6 tablets up to 4 times a day (up to 20-30 g per dose), drink 200-400 ml of water. With repeated use, the drug can cause constipation.
• Mezim forte are film-coated tablets containing pancreatic enzymes that normalize the digestive processes disturbed by poisoning. The drug has contraindications such as acute pancreatitis or exacerbation of chronic pancreatitis. Unless the doctor has prescribed otherwise, Mezim Forte is taken 2-4 tablets per meal. The tablets are drunk without chewing, with a sufficient amount of water. The medicine is well tolerated at any age. Allergies, flatulence are rarely noted.
• Cerucal is an antiemetic that can be taken orally or intramuscularly. Adults and adolescents are administered 1 ampoule (10 mg of the active substance metoclopramide) up to 4 times a day. Possible side effects include feeling tired, headache, drowsiness, tinnitus.
• Nifuroxazide - available in the form of capsules and sachets with a powdery substance, belongs to the category of antibacterial drugs. May cause allergic reactions such as rash, itching, hives. Nifuroxazide is taken 1 capsule (200 mg) up to 4 times a day, for no more than one week.
• No-shpa is a drug of drotaverine, its full analogue. Relaxes smooth muscles, eliminates spasms and thus reduces pain. No-shpu should be taken 1-2 tablets 2 times a day. The drug is contraindicated in pregnancy and lactation, hypotension.

Regardless of the severity of the poisoning, especially with a complex and prolonged course of pathology, it is recommended to use probiotics (eubiotics), which are preparations of live bacteria and their components that improve the state of the intestinal microflora. The optimal medicines, depending on age, are Bifiform complex and Bifiform baby, which take respectively 2-3 capsules 2-3 times a day and 1 chewable tablet three times a day. Duration of admission is 2 weeks.

Any drugs and their combinations can only be selected by a doctor, having previously excluded surgical pathologies and making sure that there are no complications. [14]

Herbal treatment

Herbal remedies may be more readily available as they are nearly always on hand and can be prepared quickly. Therefore, medicinal herbs often become a kind of "first aid" in case of poisoning. The greatest effect is observed when using such plants:

• Horse sorrel: add 30 g of horse sorrel rhizome to 500 ml of boiling water. They drink 1-2 sips during the day.
• Chamomile: dry chamomile flowers in the amount of 2 tbsp. L. Pour 1 liter of boiling water, drink half a glass several times during the day.
• Dandelion: leaves and flowers of the plant in the amount of 6 g are brewed in 200 ml of boiling water, insisted. Drink three times before the main meal.
• Mint: Mint leaves are brewed like tea. Drink during the day.
• Melissa: pour 40 g of a dry plant with 500 ml of boiling water, insist, divide into four parts. Drink four approaches before meals.
• Ginger root: grind 10 g of ginger rhizomes, brew in 200 ml of boiling water. Drink 1-2 tbsp. L. Every 15 minutes.

In addition to simple herbal teas, herbal mixtures can also be taken, which show a greater effect in restoring normal digestive processes. The most popular are the following recipes:

• Brew 80 g of mint leaves and 20 g of centaury in 1 liter of boiling water, insist until cool, filter. Drink during the day in four doses, before meals.
• An equal mixture is made of mint leaves, St. John's wort, chamomile, plantain, agrimony. Pour 20 g of a mixture of 0.5 l of boiling water, insist until it cools, filtered. Drink throughout the day.
• Make an equal mixture of yarrow and wormwood. One tablespoon of the mixture is poured into 0.5 liters of boiling water, insisted and filtered. Drink throughout the day in 4-5 receptions.

Prevention

In order to avoid tomato poisoning, the following recommendations should be followed:

• try not to apply, or use minimal amounts of chemical fertilizers when growing vegetables;
• do not consume unripe fruits, suspicious (bad smelling, unpleasant taste or damage);
• be sure to rinse the tomatoes well just before use;
• for canning, choose ideal fruits, use clean containers, follow all the rules for preparation and pasteurization;
• inspect each fruit before buying and eating;
• before using canned products, pay attention to the expiration date, the condition of the can, lid, brine, the taste and smell of the tomato after opening the canned food.

If you follow all the precautions, you can prevent the likelihood of poisoning and get only the benefits of eating vegetables.

How to Avoid Solanine Poisoning in Green Tomatoes?

Green tomatoes contain a lot of specific substances that prevent oxygen from entering the circulatory system, which can negatively affect the level of hemoglobin and complicate the liver. As a result, intoxication may develop.

To avoid negative consequences, it is not recommended to use unripe fruits without heat treatment. To reduce the concentration of solanine and other harmful components of tomatoes, you can:

• pour over boiling water;
• fry;
• soak in cold salted water for several hours, changing the liquid periodically;
• bake or stew.

Raw unripe specimens are allowed to be eaten, but in very small quantities - no more than 2-3 small tomatoes per day.

Forecast

Tomato poisoning, with a mild or moderate severity, in most cases ends with a full recovery. Various disorders in the work of certain organs and systems can become adverse consequences, especially in children. For example, a frequent complication is a violation of the intestinal microflora, and after solanine poisoning, violations in the liver and kidneys are possible. In rare cases, with severe poisoning, multiple organ failure develops, which requires urgent intensive treatment.

If tomato poisoning is registered in a child, then he is necessarily hospitalized in the toxicological or pediatric department of the hospital. Life-threatening or critical conditions are indications for admission to the intensive care unit. For the overwhelming number of patients with uncomplicated course of intoxication, the prognosis remains favorable.