Watermelon poisoning of an adult and a child

Delicious delicate pulp, many useful properties: dissolves salts and prevents their deposition, stimulates the outflow of bile and excretion of toxic substances from the body - this is watermelon. It is rich in the antioxidant lycopene , organic acids, vitamins and minerals, and is low in calories. Almost everyone can eat it, and at 2-2.5 kg per day, and for many diseases it is strongly recommended. 

The characteristic aroma of watermelon comes from medium and short chain fatty acids, as well as geranial, ß-ionone and neral. Its consumption has increased due to its rich nutritional profile and associated health benefits. It is effective in reducing the prevalence of cancer, cardiovascular disease,  [1]diabetes, and macular disease. Taking into account the nutritional profile, consuming 100 g of watermelon provides 30 kcal. It contains almost 92% water and 7.55% carbohydrates, of which 6.2% are sugars and 0.4% dietary fiber. It is enriched with carotenoid, vitamin C, citrulline, carotenoids and flavonoids, does not contain fats and cholesterol, therefore it is considered a low-calorie fruit (Leskovar et al., 2004; Bruton et al., 2009). In addition, watermelon is a rich source of ß-carotene, which acts as an antioxidant and a precursor to vitamin A. In addition to lycopene, it is a source of B vitamins, especially B1 and B6, as well as minerals such as potassium and magnesium (Huh et al., 2008). Watermelon contains phenolic compounds that are quite comparable to those of other fruits (Kaur and Kapoor, 2001; Jaskani et al., 2005).  [2]

However, watermelon poisoning in the summer is a common feature. Such cases occur quite often. How can you get poisoned with such a wonderful product?

Epidemiology

The exact statistics of this kind of poisoning is unknown, especially since in the summer-autumn period, nitrates can be found not only in watermelons. However, experts still note that more cases of watermelon poisoning occur in June-July, when the early giant berries appear on the shelves. Acute bacterial intestinal infections in statistical development are usually classified by the type of pathogen, and not by the food in which they were found and multiplied.

Causes of the watermelon poisoning

This is mainly due to violation of the rules for the cultivation, transportation and storage of watermelons. You cannot poison yourself with a good quality watermelon. Poisoning in most cases occurs due to the excess content of nitric acid mineral substances due to the fact that the watermelon is grown on soil generously fertilized with saltpeter. The nitrates contained in the fertilizer are fairly neutral compounds. But in the body, they are reduced to nitrites - highly toxic poisons that cause symptoms of acute intoxication.

Nitric acid salts are found in small quantities everywhere, including in living organisms and in the soil. They are a necessary component of metabolic processes, however, their use often exceeds the permissible limits. Agricultural producers pursue their goal of increasing yields. Intensive feeding of plants with saltpeter promotes earlier ripening of fruits. Therefore, it is most dangerous to buy watermelons that hit the shelves in early summer. They are definitely grown on abundantly fertilized soils.  [3]

Even with moderate use of fertilizers, there are risk factors for the accumulation of excess nitric acid salts in products and in the body. The former include regular annual fertilization of the soil, contributing to its mineralization, and drought. The second is the regular use of watermelons with a moderate nitrate content by people with insufficient methemoglobin reductase activity. They gradually develop chronic poisoning. At risk are infants and young children, as well as elderly people. [4]

 

Pathogenesis

The pathogenesis of nitrate poisoning begins with the ingestion of a watermelon saturated with fertilizers into the digestive tract. Being rapidly absorbed into the blood, nitrates are reduced to nitrites, which react with hemoglobin molecules. Methemoglobinemia develops: the inability of the blood to perform one of its main functions - to transfer oxygen molecules to organs and tissues, which leads to increasing hypoxia of the body with the ensuing consequences - the development of organic and tissue dystrophy and organic lesions against their background. [5], [6]

You can get poisoned not only with nitrates, a watermelon can be clean in this regard, but damaged - knocked down, cracked, crumpled, overripe. In such cases, pathogenic microorganisms begin to actively multiply in the sweet pulp of the watermelon. Also, pathogens of intestinal infections from a poorly washed watermelon peel or from unwashed hands can get on the pulp or directly into the mouth and cause poisoning. A serious risk factor for getting an intestinal infection is cutting a dirty watermelon with a sticky knife right next to the scale to demonstrate its ripeness. [7]

How long does watermelon poisoning manifest? It depends on many components: the amount eaten, the type of toxic agent, the age and condition of the poisoned person. On average, two to six hours pass before the first symptoms of nitrate poisoning appear, the incubation period of "dirty hands diseases" can last for several hours, and often is a day or more, so sometimes poisoning is no longer associated with the use of a watermelon cut with a dirty knife. [8]

Symptoms of the watermelon poisoning

Whatever the cause of the poisoning after drinking watermelon, the first signs will look like the body is trying to get rid of the poisonous substance - nausea and vomiting will appear in order to eliminate inappropriate stomach contents, diarrhea - as a means of cleaning the intestines, pain and rumbling in the epigastrium and / or lower part belly. The presence and strength of other manifestations of intoxication will correspond to the amount eaten and the type of toxic substance in the watermelon.

Symptoms of watermelon poisoning in an adult and a child are not very different, it is just that the child's body reacts to the ingestion of a much smaller amount of toxins. Therefore, there are situations when everyone ate a watermelon, but only one suffered. Often it is a small child or elderly person. [9]

The classic manifestations of food poisoning (abdominal pain, vomiting and diarrhea) are usually accompanied by symptoms such as severe weakness, sweating, high fever, chills, aches throughout the body, and headache.

Nitrate poisoning when drinking watermelon manifests itself in the same way as a bacterial infection, but with a high content of them, metglobinemia and tissue hypoxia develop. Neurological symptoms appear - the patient is dizzy, noises in his ears, he moves "along the wall", the skin turns pale, cyanosis appears, his fingers and toes become cold. The patient may complain of discomfort on the right under the rib (in the area of the liver), in some, the sclera of the eyes and skin turn yellow. He becomes drowsy, consciousness can be confused, there can be a depression of mental activity or, conversely, an abnormally excited state. The state of health is getting worse - breathing and heart function are disturbed, fainting occurs, a coma may occur. [10]

The development of methemoglobinemia can be suspected by the patient's appearance, his skin acquires an earthy, dirty gray tint, and the mucous membranes become dark bluish. With a mild degree, there may be no other pronounced symptoms, except perhaps increased fatigue, which is often not correlated with the use of watermelon.

In addition, sometimes chronic nitrate poisoning develops, proceeding with mild symptoms - increased fatigue, hypovitaminosis, as it accumulates, an increasingly pronounced dysfunction of vital organs. Symptoms of acute intoxication are usually observed when the level of methemoglobin in the blood is more than 15-20%. [11]

Poisoning with an old watermelon is manifested by the symptoms listed above. However, the concept of "old" is not very correct. Apparently, this means a spoiled fruit - with a sour, spoiled sluggish pulp. In such a watermelon, the bacterial flora is already multiplying, and it is at least unreasonable to eat it - the outcome is a foregone conclusion. It is better to throw it away.

Foodborne infections manifest themselves in different ways, depending on which pathogen was eaten with the watermelon and in which parts of the gastrointestinal tract it will multiply.

When colonizing the stomach (staphylococci, streptococci, E. Coli, Proteus, Shigella, Salmonella, Klebsiella and others), acute gastritis syndrome is observed. The patient notes discomfort (heaviness and pain) in the epigastrium. This area responds to deep palpation with increased pain. Nausea and repeated vomiting are characteristic. [12]

The reproduction of these same pathogenic organisms in the small intestine can cause symptoms of acute enteritis syndrome. The stomach growls, periodically in different places cramping pains are felt. Severe diarrhea is characteristic. Stools are profuse, watery, and light, often with foam and lumps of undigested food.

Cramping pains in the lower abdomen, often on the left, accompanied by tenesmus, frequent urge to defecate, scanty stools with a feeling of incomplete emptying of the intestines speak of acute colitis. Flatulence and rumbling are characteristic. The frequency of going to the toilet can be up to 25 times a day. The stool is at first profuse and foul-smelling, turns over time into a liquid and watery with mucus, traces of blood and even pus. [13]

Lesions of all parts of the gastrointestinal tract are accompanied by general infectious manifestations - fever, weakness, headache, expressed to varying degrees.

The main complication of bowel inflammation is dehydration.

Watermelon poisoning during pregnancy

A tasty giant berry is useful for pregnant women, however, only high-quality, grown in the most natural conditions, without dents and damage. The pulp of watermelon contains iron and folic acid, other vitamins and minerals necessary for expectant mothers, allows you to quench your thirst without causing edema, and also to establish regular bowel movements. To minimize the possibility of watermelon poisoning, a pregnant woman should try to follow the simple rules of prevention set out at the end of the article. [14]

Nevertheless, feeling unwell after drinking watermelon, a woman in an "interesting" position should not hesitate to seek medical help. Watermelon poisoning in a pregnant woman proceeds with the same symptoms as everyone else. During the period of bearing a child, it is a danger to both. In pregnant women, frequent vomiting and diarrhea can quickly become dehydrated. Women with a history of varicose veins are at risk of developing thrombosis as an undesirable consequence of a lack of water in the body. Against the background of dehydration, the blood in the vessels becomes thicker and its volume decreases, which contributes to an increase in the level of oxytocin in it. This peptide hormone stimulates the smooth muscle tissue of the uterus to contract, increasing the risk of miscarriage or premature birth. [15]

There is a small likelihood of intrauterine intoxication of the fetus due to the penetration of toxic substances (nitrates, bacteria) through the placental barrier.

In view of all these consequences, pregnant women should meticulously choose their watermelons and buy them only during the season (August-September).

Watermelon poisoning while breastfeeding

For a baby, it is preferable that his nursing mother was poisoned by an old and sour watermelon, that is, with the usual not too severe food poisoning, you can not even interrupt breastfeeding. The causative agents of intestinal infections affect the lower parts of the digestive system of a woman, while the penetration of microorganisms themselves and their metabolic products into breast milk is considered unlikely. Therefore, the decisive factor is the condition of the nursing mother - if she is able to feed, and she does not need antibiotic therapy and hospitalization, then the child is not in danger, and there is no need to deprive him of natural feeding. [16]

Poisoning with nitrate watermelon is much more dangerous for a child. Nitric acid salts pass well into breast milk. And children of the first year of life are predisposed to the development of methemoglobinemia much more than adults. Their endogenous regulation mechanism is still imperfect. The enzyme methemoglobin reductase in infants under four months of age does not yet work in full force, the intestinal microbiocenosis also contributes to the formation of this dangerous compound. Even hemoglobin in newborns of the fetal (fetal) type, which is oxidized much better than in an adult. Therefore, a child, especially in the first months of life, can be fatally poisoned by nitrates obtained through breast milk. [17], [18]

The clinical picture of poisoning in infants differs from that of adults. They may not have vomiting and diarrhea. The child will become lethargic and drowsy, and may develop shortness of breath, cyanosis, and seizures. [19], [20]

Watermelon poisoning in children

As a result of the use of low-quality watermelon, a child, like an adult, may experience symptoms of poisoning, the severity of which will depend on the amount eaten, the type of intoxication, the child's age and individual sensitivity.

Foodborne toxicity is more likely to manifest with abdominal pain, vomiting and diarrhea against a background of weakness and, possibly, high fever.

Nitrate poisoning in young children will primarily affect the circulatory system. They will have predominant neurological symptoms - weakness, drowsiness, dizziness, headache, coordination disorder. In severe cases, there may be convulsions, respiratory failure, coma development. Typical symptoms of poisoning in young children may be blurred or even absent.

The older the child is, the more the clinical picture will correspond to the "adult" manifestations. [21]

If the symptoms of discomfort appear in a child within two to six hours after drinking watermelon, and they increase, you should immediately seek medical help.

Complications and consequences

Watermelon poisoning of mild severity usually does not require hospitalization and goes away without consequences.

Severe poisoning, especially those associated with an increased content of nitrates, can be complicated by allergic reactions, inflammatory processes in the liver or pancreas, dehydration and impairment of almost any type of metabolic processes as a result. Any organs can be affected, especially if a person suffers from any chronic disease. Watermelon poisoning can exacerbate it. [22]

Nitrites are highly toxic and carcinogenic. [23],  [24],  [25] Damage as a result of poisoning watermelon, primarily applied to the circulatory system suffers from the central nervous system and digestive organs. When half or more of the hemoglobin contained in the blood is oxidized to methemoglobin, there is a high probability of death.

Often, users ask the question: How many days does watermelon poisoning take? Acute symptoms - vomiting and diarrhea can pass quickly, and the consequences of severe poisoning can remain with the victim for life in the form of chronic dysfunction of any organ. It depends on many factors, mainly on the aggressiveness of the poisonous agent (after all, the watermelon itself is not toxic) and the individual characteristics of the victim's body. [26]

Diagnostics of the watermelon poisoning

To effectively treat watermelon poisoning, it is necessary to establish which toxic agent caused it. Blood tests are required - clinical, biochemical and hemoglobin fractions. An experienced laboratory assistant can determine methemoglobinemia already during blood sampling - the blood acquires a brownish-brown tint. Bacterial feces or more modern methods - PCR, enzyme-linked immunosorbent assays will help identify the causative agent of intestinal infection.

A general urinalysis will determine how the kidneys are working. If liver damage is suspected, liver function tests are prescribed. In severe poisoning with complications, instrumental diagnostics are prescribed according to indications. [27]

Differential diagnosis

The examination results are analyzed, differential diagnostics is carried out. In case of poisoning with watermelon, to determine the tactics of treatment, it is necessary to establish what caused the clinical manifestations of acute intoxication: intestinal infection or nitrate poisoning.

Treatment of the watermelon poisoning

First aid to the victim should be provided at home when symptoms of poisoning appear. Most often, with a prompt response to the first signs of trouble, home procedures can be dispensed with. What to do in case of watermelon poisoning? First of all, it is necessary to remove the remnants of undigested watermelon with toxic substances from the digestive canal as quickly as possible. To do this, the stomach is washed several times , at least with clean boiled water at a temperature of about 30-35 ° C. Cold water is not used, as there is a risk of gastric spasm, while hot water promotes more intense absorption of toxic substances into the stomach walls. [28]

You can add a little potassium permanganate to the water (a filtered, slightly pink solution without crystals) or baking soda (one tablespoon per liter jar). They will have an antiseptic effect.

You need to drink a lot of liquids at a time, an adult - four to six glasses. Then - induce vomiting, and repeat the procedure until clear water begins to leave the stomach. It is better not to do this procedure for small children. It is also contraindicated if the victim is in a semi-faint state.

An enema will help cleanse the lower intestines, however, it is done if there is no diarrhea. [29]

What to take in case of watermelon poisoning? After cleaning the stomach and intestines, the victim is given drugs that bind toxic substances (enterosorbents).

Any home medicine cabinet usually contains activated charcoal . This is the most primitive sorbent. It absorbs everything - both useful substances and toxic ones. However, if there is nothing else in the first aid kit, then it is fine. It is taken from the calculation: one tablet per ten kilograms of the victim's weight. For greater effect, tablets are recommended to be crushed and mixed with a small amount of water, and then to drink a charcoal suspension.

More modern means of this group Enterosgel , Atoxil, Polysorb are based on silicon. They absorb toxic substances, pathogenic microorganisms and products of their metabolism from gastric and intestinal contents. In addition, absorption also occurs from the blood - the drug molecules bind to the molecules of toxic substances through the membranes of the villous epithelium of the intestinal mucosa. Enterosgel is a ready-to-use hydrogel methylsilicic acid. Atoxil and Polysorb are produced in the form of a highly dispersed silica powder, from which a jelly-like suspension is prepared by diluting it with water. The hydrogel has an enveloping effect, protecting the gastrointestinal tract from aggressive substances, does not inhibit the beneficial microflora, helps to restore smooth muscle tone and normalize peristalsis. The absorbed toxic substances and the hydrogel itself is eliminated from the body with feces. Sorbents do not penetrate into the systemic circulation. They practically have no contraindications and side effects. [30]

If the manifestation of poisoning is predominantly diarrhea, you can use a remedy such as Smecta . The active ingredient of the drug is a double (aluminum-magnesium) salt of silicic acid acts as an enterosorbent, strengthens the barrier function of the mucous membrane of the alimentary canal, and prevents disruption of the water-electrolyte balance. The drug is available in the form of a powder for suspension immediately before use.

The victim needs to drink plenty of clean water. Frequent vomiting and severe diarrhea may require rehydration therapy. In such cases, Rehydron is used, which contains table salt, glucose, sodium and potassium salts. The sachet is diluted in a liter of boiled water and given to the patient to drink after each loss of fluid.

An injured person who has lost a lot of fluids and electrolytes during the acute period of poisoning needs to eat well during the recovery period. His diet should contain a variety of foods, including all the essential vitamins and minerals. A special diet after watermelon poisoning is not required, although you need to adhere to the principles of fractional nutrition (eat in small portions and often), avoid fatty, fried, abundance of confectionery and fresh baked goods. In case of complications on the internal organs, the attending physician will tell you individually which diet to follow. For example, if the kidneys are affected, it is recommended to eat unsalted food, in case of liver damage, table number 5 is recommended . [31]

For mild cases of watermelon poisoning, home treatment can help. However, if there is no relief from home detoxification, you should definitely seek professional help. The patient may need resuscitation measures aimed at ensuring the functions of breathing, cardiac activity, therapy to maintain the functioning of the liver and kidneys, and blood circulation. In case of poisoning with nitrates and pronounced signs of oxygen starvation (the level of methemoglobin in the blood is about 30%), antidote therapy may be required. It is carried out in a hospital with intravenous administration of methylthioninium chloride.

High doses of ascorbic acid are also used and administered intravenously in hospitals.

Treatment is symptomatic, and its tactics entirely depend on the condition of the victim.

Gastric lavage is the main first aid procedure, which is unanimously recommended by all areas of medicine - both folk and homeopathy. Moreover, all the same pure water or solutions of soda, potassium permanganate or salt are used. Salt solution causes many to gag on their own. You don't even need to induce vomiting. Enemas are actively used to cleanse the lower intestines. The solution is made in proportions - a tablespoon of ordinary table or sea salt to a liter jar of water at body temperature.

Alternative treatment for poisoning begins after gastric lavage. Cinnamon drink is considered an antidote for toxic nitrogenous substances. It is prepared as follows: 3-4 cinnamon sticks are poured with water (500 ml), brought to a boil and cooked for about five minutes. Then the broth is slightly cooled (3-5 minutes) and filtered. Consume until it has cooled down, in two or three doses.

Alternative healers recommend in case of poisoning not to lie in a layer, but to move. After washing the stomach and intestines, the absorbed toxic substances are also excreted through the skin. Mobility stimulates this particular route of elimination, in addition, wet rubbing, baths, showers, baths and saunas are used for detoxification. Naturally, if the patient is in a semi-faint state, then such methods of treatment should not be resorted to. [32]

Rehydration can be carried out with a solution prepared from ordinary table salt (3 g) and sugar (18 g), diluted in a liter of water.

During the recovery phase, herbal treatment is applied. The victim is given to drink a decoction of valerian root, a mixture of yarrow and wormwood, horse sorrel roots, infusions of chamomile flowers, calamus or dill seeds. You can add a teaspoon of honey to infusions and decoctions.

After poisoning, the patient should drink a lot - pure water, tea: ginger, green, black, but it is better to abstain from food on the first day, and then adhere to a sparing diet (liquid dishes, mucous cereals).

After gastric lavage, homeopathic medicines can be used to help reduce the undesirable consequences of watermelon poisoning and quickly put the victim on his feet. The main remedy for bacterial poisoning is Arsenicum album; Nux vomica and Hina are also used. In case of poisoning with nitrates, their excretion can be accelerated by the preparations Acidum nitrikum, Argentum nitrikum, Kalium nitrikum.

Complex homeopathic preparations Nux Vomica Gomacord, Gastrikumel, Galium Heel, Coenzym compositum can help the body quickly cope with intoxication and avoid complications from the digestive system, blood circulation and nervous system.

Undoubtedly, the effectiveness of homeopathic remedies will be ensured when the drug is prescribed by a doctor who is familiar with the principles of their action.

Prevention

Watermelons are plants that absorb fertilizers well from the soil. Therefore, you need to buy and eat them only during the season, that is, in August-September. You need to choose ripe watermelons, without dents, with an intact crust. It should be firm, not matte, but glossy, durable (it is difficult to make a puncture on it with a fingernail). After tapping on the peel of the watermelon, a booming sound should be heard. The spot on which the watermelon lay on the ground is yellow in ripe fruit, not white. When buying, you should not determine ripeness by notching, this is associated with the risk of poisoning.

At home, the watermelon rind must be thoroughly washed with soap, dried and only then cut. The cut watermelon should not contain dense yellow veins, nitrates have accumulated in them. You should not finish eating a slice of watermelon to the very green rind, leave a little pink flesh on it. It is under the crust that the most nitrogenous compounds accumulate.

It is recommended to grind a piece of watermelon in a glass cup of water. She shouldn't turn pink. If the watermelon is normal, the water will simply turn cloudy and whitish.

It is not recommended to mix it with other products. Nutritionists say that watermelon should be eaten separately from them and kept for about an hour before eating other food.

Pregnant women, lactating mothers and the elderly should be discreet when consuming watermelon, children also need to dose it.

Forecast

In the overwhelming majority of cases, watermelon poisoning does not die, moreover, such troubles are often dealt with at home, which is facilitated by modern enterosorbent drugs. Timely appeal to a medical institution in severe cases of poisoning also helps to save the lives of the victims. However, some care must be taken with this tasty and healthy giant berry.