Can Neem Oil be Toxic?

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Neem oil
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A 73-old male presented with toxic effects of Neem oil after ingesting only 20 mL of it!

Neem oil has anti-fungal, anti-bacterial, and insect repellent properties due to which it has maintained its position in traditional medicine. It is used to treat several skin diseases too. Neem oil comprises mainly triglycerides, steroids, and triterpenoids. However, besides the benefits, there have been reports of its toxicities in children, infants, and even in adults. However, toxicity in adults is less common. In infants and children, It may cause hepatotoxicity, vomiting, metabolic acidosis, and encephalopathy. In adults, it may cause vomiting, encephalopathy, metabolic acidosis, visual loss, and seizures. Azadirachtin is the main compound linked to the toxic effects of Neem oil.

Here is a case report describing a 73-year-old man with a history of type II diabetes mellitus and psoriasis. He presented to the emergency department 1 hour after the ingestion of Neem oil with complaints of drowsiness and vomiting. History revealed that he had ingested approximately 20 mL of Neem oil.

His usual medications included human Mixtard insulin (30/70). He regularly took 16 U before breakfast and 10 U prior to dinner.

On examination in the emergency department, he was drowsy with a Glasgow coma scale score of 13/15. His vitals revealed a pulse rate of 110/min, blood pressure of 150/90, respiratory rate of 28/min, and oxygen saturation of 95% at room air. However, his physical examination was unremarkable with normal systemic examinations.

In the ED, the patient started convulsing and lost consciousness. The doctors intubated him. Moreover, they administered intravenous lorazepam. After shifting him to the intensive care unit, he received insulin and symptomatic treatment.

Serology revealed hemoglobin 13.3 gm/dl, leukocyte leukocyte count 16800/μl, red blood cell count 4.41 million/cmm, platelet count 375000/μl, blood sugar 298 mg/dl, serum osmolality 277 mosmol/kg, and normal serum lactate level.

An arterial blood gas analysis showed metabolic acidosis. The rest of the test results were normal with normal urine analysis, serum electrolytes, liver, renal, and thyroid function. Moreover, ECG and chest radiograph were also normal.

Brain magnetic resonance imaging revealed chronic ischemic changes due to small vessel disease.

On the second and the third day, the doctors repeated the investigation. The results revealed normal electrolytes, arterial blood gas, liver, and renal function.

During the hospital stay, he remained drowsy for 4 days, however he recovered without any long-term complications.

The doctors discharged him 1 week later.

SOURCEIndian Journal of Critical Care Medicine
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Dr. Arsia Parekh
Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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