Tomato poisoning

Everyone knows that vegetables are extremely healthy, including tomatoes. Juicy tomatoes often end up on our tables: fresh in the summer and home-canned in the winter. However, few people know that tomato poisoning is a fairly common occurrence that occurs as a type of widespread 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 consuming low-quality products, every tenth person in the world falls ill every year, and more than 400 thousand of them die.

The risk is increased in children under five years of age: about 125 thousand pediatric patients die from food poisoning every year. The highest incidence is recorded in 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 makes up only 9% of the entire population of the planet. The most common causes of intoxication are bacteria, viruses, parasites, toxic and chemical substances.

The risk of poisoning is particularly high in low- and middle-income regions and is associated with the use of unsafe water for food preparation, poor hygiene and improper cooking and storage conditions, lack of food safety criteria or inadequate quality control.

No specific calculation of the number of poisonings specifically from tomatoes has been conducted.

Causes tomato poisoning

Tomato poisoning does not always occur, but only for certain reasons. In general, tomatoes are safe to eat if they were grown correctly, preserved, stored in normal conditions, etc.

Why do people sometimes get poisoned?

• Vegetables that are treated with various chemicals to improve/accelerate growth, eliminate insect pests and optimize storage may pose a danger to human health. Some reagents are absorbed by tomatoes and then enter our body after consumption. Ingestion of toxins in large quantities causes severe poisoning.
• Bacteria enter the digestive tract if tomatoes are not washed before consumption, 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 subsequently cause the development of poisoning. Spoiled fruits should be thrown away without regret.
• Unripe tomatoes can cause poisoning if consumed raw in large quantities. This is due to the content of solanine, tomatine and lycopene in green fruits. A single consumption of 5-6 unprocessed tomatoes can cause quite severe intoxication.
• Canned vegetables can cause poisoning if the rules of preservation and pasteurization were not properly observed during their preparation. For example, poisoning cannot be avoided if the tomatoes were poorly washed, were damaged, or if the rules for storing canned food were violated.

Even vegetables that have been grown and processed in compliance with all necessary conditions can cause harm. For example, if a person has an individual hypersensitivity to nightshades, then he should completely eliminate tomatoes from the diet, regardless of their type and cooking method. [ 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, follow hygiene rules, eat only washed and processed foods, etc.

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

• Women during pregnancy. During pregnancy, changes occur in the circulatory system and metabolic processes in the female body, the immune system is weakened, which can increase the risk of intoxication.
• Old people. 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. Children's bodies are often unable to resist toxic agents, which is due to the still imperfect development of the immune and digestive systems.

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

Pathogenesis

If tomatoes were grown and stored correctly, reached their maturity and were adequately prepared in compliance with sanitary and hygienic recommendations, then it is almost impossible to get poisoned by them. If there was a violation at any stage, then the possibility of intoxication cannot be ruled out. Why can this happen?

An adverse effect on the composition of vegetables occurs if the fields are in close proximity to major highways, chemical plants, landfills, settling ponds, etc. Harmful substances that penetrate the fruits can cause severe poisoning if consumed further. In addition to the unfavorable environmental situation, negative effects are noted when treating fields and crops with chemical fertilizers, pest control agents, 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 in such tomatoes that are dangerous to health - primarily solanine.

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

However, according to statistics, the greatest number of poisonings is not associated with the presence of solanine, but with the consumption 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 tomato poisoning

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

The main signs of tomato intoxication are considered to be the following:

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

In case of severe poisoning with neurotoxic substances, the following symptoms may 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;
• loss of muscle tone.

These symptoms are typical of an infection called botulism, a dangerous condition that requires immediate medical attention. [ 5 ]

The severity of the clinical picture is directly dependent on the amount of tomatoes consumed. If the patient has eaten few low-quality vegetables, the symptoms subside relatively quickly, but if a lot, they intensify and become more complicated. [ 6 ]

In severe poisoning, certain symptoms may be present even during the recovery stage. Many patients continue to be bothered by:

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

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

Green Tomato Poisoning

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 poisonous 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 to the fruit from mold. As vegetables ripen, the content of this poison decreases, so the lighter and redder the fruit, the safer it is. It is worth noting that in small concentrations, solanine is even useful: it strengthens the cardiovascular system and has antiviral activity. However, if you eat 5-6 deep green tomatoes, poisoning is almost guaranteed. [ 8 ]

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

• Lycopene is a powerful antioxidant that can prevent DNA mutations and the development of cancer, prevent lens pathology and atherosclerosis. However, an overdose of this substance is dangerous in terms of poisoning. [ 9 ]
• Tomatine is an active antioxidant and immunomodulator, is the basis of the well-known drug cortisone. Excessive use of tomatine can cause serious poisoning.

Experts explain: in order for an adult to benefit from unripe tomatoes and not get poisoned, one should choose fruits of a light green color and eat them in quantities not exceeding 300 g per day. Green tomatoes should not be given to children. When heat-treated, the concentration of hazardous substances in vegetables is significantly reduced.

Fresh Tomato Poisoning

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 due to improper or insufficient fertilization of plants during growth, deficiency or excess of watering.

Diseased plants, such as those with blossom-end rot, are not recommended for consumption. Even if you carefully cut out the brown affected spot, the infection may remain on seemingly healthy parts of the vegetable. If you eat such a tomato, a person may develop digestive disorders, and the intestinal microflora is disrupted.

You can get poisoned even if you eat tomatoes that were near a rotten one without washing them first. Washing vegetables and fruits thoroughly immediately before eating is an important rule for preventing intoxication and digestive disorders.

Canned Tomato Poisoning

In winter, tomatoes are consumed mainly in canned form. These can be pickled and fermented 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 preparations can cause poisoning. The reasons may be as follows:

• insufficiently washed and poorly sterilized containers for preservation;
• using broken, rotten, spoiled tomatoes, poorly washed greens;
• incorrect preparation of brine;
• use of insufficiently tight, non-hermetic lids;
• storage in unsuitable conditions, or storing an already opened can for too long.

The first signs that a product poses a danger in terms of poisoning are:

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

Spoiled canned tomatoes should not be eaten and should be thrown away.

Poisoning by cucumbers and tomatoes

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

However, if fertilizers are not applied to the soil on time or in the wrong dosage, the nitrate content in vegetables will exceed the safe concentration.

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

• severe fatigue, headache;
• dizziness;
• abdominal pain, heart;
• darkening of the vision;
• digestive disorders.

Poisoning occurs when the safe daily dose threshold is exceeded, which for an adult is 3.7 mg/kg of 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 fruit, then the risk of intoxication increases significantly. Usually, tomatoes contain a relatively low concentration of the toxic compound - about 80-100 mg/kg of product (for comparison: watermelons, melons, beets can accumulate up to 5 thousand mg of nitrogen salts).

Complications and consequences

Complications from tomato poisoning develop relatively rarely - mainly in patients with concomitant chronic pathologies, as well as in elderly patients, children, and 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 rapid loss of fluid);
• acute cardiac failure, arrhythmia;
• infectious toxic shock, which is accompanied by an increase in temperature, impaired consciousness, etc.
• Fatal cases of solanine poisoning have been described.[ 10 ]

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

Diagnostics tomato poisoning

It is not difficult to suspect tomato poisoning. The anamnesis includes the fact of eating a poor-quality or suspicious fruit, after which, after a few hours, the following symptoms were discovered:

• dyspepsia (nausea, vomiting, diarrhea, bloating);
• pain in the stomach, intestines;
• general intoxication (weakness, fever, rapid heartbeat, pale skin, cold sweat).
• Tests may include:
• bacteriological examination of vomit, feces, food residues;
• general blood and urine analysis;
• biochemical blood test, coagulation test.

Instrumental diagnostics are necessary to assess the degree of damage to internal organs and systems. Diagnostic procedures such as ultrasound, electrocardiography, radiography, colonoscopy, gastroduodenoscopy, magnetic resonance imaging or computed tomography may be prescribed.

Differential diagnosis

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

• acute attack of appendicitis;
• meningitis, acute or transient cerebral circulatory disorders, subarachnoid hemorrhages;
• 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, toxicosis of pregnancy, ovarian cyst torsion, pelvic peritonitis.

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 poisoning, the doctor prescribes treatment that is suitable for a specific pathological situation.

Treatment tomato poisoning

Treatment procedures for tomato poisoning most often consist of the following stages:

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

When to see a doctor:

• in case of uncontrollable vomiting, severe weakness caused by increasing dehydration of the body;
• if we are talking about a child;
• if there is an increase in temperature, convulsions;
• if the condition worsens sharply, bloody vomiting, yellowing of the sclera, problems with breathing or swallowing appear;
• if a pre-syncope or fainting condition 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. The lavage is carried out until clear water without inclusions comes out.
2. Cleansing the intestines. If there is diarrhea, then there is no need to stop it, as it promotes natural cleansing of the intestines. If there is no emptying, then you can put several cleansing enemas.
3. Taking sorbents. After completing the previous procedures, the patient is given any sorbent preparation to drink. The following are excellent: white or activated carbon, Enterosgel, Atoxil, etc.
4. Replenishment of fluid levels in the body. It is recommended to drink plenty of fluids. You can drink clean warm water, green tea, chamomile, mint, calendula infusion, Regidron and other similar solutions.

On the recommendation of the attending physician, symptomatic treatment is prescribed. In some cases, antibiotic therapy is necessary: 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 increased gas formation;
• means that improve the quality of intestinal microflora.

If the patient experiences severe vomiting and the condition threatens to develop dehydration and complications, the doctor may prescribe antiemetic drugs.

The diet of patients who have been poisoned by tomatoes should be severely limited, with a focus on dietary table No. 4. On the first day, it is recommended to completely abstain from food. As the condition normalizes, slimy soups, rice porridge, vegetable broths, mashed meat and fish, omelette, vegetable puree, fresh cottage cheese, jelly, dry bread and biscuits are introduced into the diet. Milk, raw vegetables and fruits, canned goods, sausages, smoked meats, and spices are excluded for several days. It is recommended to adhere to a gentle diet for 2-4 weeks (depending on the degree of poisoning). [ 13 ]

Medicines

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

• Activated carbon – comes in black tablets, sold 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), washed down with 200-400 ml of water. With repeated use, the drug may cause constipation.
• Mezim forte is a film-coated tablet containing pancreatic enzymes that normalize digestive processes disrupted by poisoning. The drug has contraindications, such as acute pancreatitis or exacerbation of chronic pancreatitis. Unless otherwise prescribed by the doctor, Mezim forte is taken 2-4 tablets per meal. The tablets are taken without chewing, with a sufficient amount of water. The drug is well tolerated at any age. Allergies and flatulence are rarely observed.
• Cerucal is an antiemetic that can be taken orally or administered intramuscularly. Adults and adolescents are given 1 ampoule (10 mg of the active substance metoclopramide) up to 4 times a day. Possible side effects include: fatigue, headache, drowsiness, tinnitus.
• Nifuroxazide - is available in capsules and sachets with a powdery substance, belongs to the category of antibacterial drugs. Can cause allergic reactions in the form of rash, itching, urticaria. Nifuroxazide is taken 1 capsule (200 mg) up to 4 times a day, for no more than one week.
• No-shpa is a drotaverine preparation, its complete analogue. Relaxes smooth muscles, eliminates spasms and thereby reduces painful sensations. No-shpa should be taken 1-2 tablets 2 times a day. The drug is contraindicated in pregnancy and lactation, hypotension.

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

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

Herbal treatment

Herbal remedies may be more accessible, as they are almost always at hand and are prepared quickly. Therefore, medicinal herbs often become a kind of "first aid" in case of poisoning. The greatest effect is observed when using the following plants:

• Horse sorrel: add 30 g of horse sorrel rhizome to 500 ml of boiling water. Drink 1-2 sips throughout the day.
• Chamomile: 2 tablespoons of dried chamomile flowers are poured into 1 liter of boiling water, and drunk half a glass several times during the day.
• Dandelion: 6 g of plant leaves and flowers are brewed in 200 ml of boiling water and infused. Drink three times before the main meal.
• Mint: brew mint leaves like tea. Drink throughout the day.
• Melissa: pour 40 g of dry plant with 500 ml of boiling water, infuse, divide into four parts. Drink four times before meals.
• Ginger root: grind 10 g of ginger rhizome, brew in 200 ml of boiling water. Drink 1-2 tbsp. every 15 minutes.

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

• Brew 80 g of mint leaves and 20 g of centaury in 1 liter of boiling water, leave to cool, filter. Drink throughout the day in four doses, before meals.
• Make an equal mixture of mint leaves, St. John's wort, chamomile, plantain, and agrimony. Pour 20 g of the mixture into 0.5 l of boiling water, leave until cool, filter. Drink throughout the day.
• Make an equal mixture of yarrow and wormwood. Pour 0.5 liters of boiling water over one tablespoon of the mixture, let it brew and filter. Drink throughout the day in 4-5 doses.

Prevention

To avoid tomato poisoning, you should follow these recommendations:

• try not to use, or use in minimal quantities, chemical fertilizers when growing vegetables;
• do not eat unripe fruits, suspicious ones (bad smelling, with an unpleasant taste or damage);
• Be sure to wash tomatoes thoroughly immediately before use;
• for canning, choose ideal fruits, use clean containers, follow all the rules of preparation and pasteurization;
• inspect each fruit before purchasing and eating;
• Before consuming canned products, pay attention to the expiration date, the condition of the can, lid, brine, and the taste and smell of tomatoes after opening the can.

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

How to avoid solanine poisoning in green tomatoes?

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

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

• pour boiling water over;
• 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

Mild to moderate tomato poisoning usually results in complete recovery. Adverse effects, especially in children, may include various disorders in the functioning of certain organs and systems. For example, a frequent complication is a violation of the intestinal microflora, and after solanine poisoning, liver and kidney disorders are possible. In rare cases, severe poisoning can lead to multiple organ failure, which requires urgent intensive treatment.

If tomato poisoning is registered in a child, he/she is necessarily hospitalized in the toxicology or pediatric department of the hospital. Life-threatening or critical conditions are indications for hospitalization in the intensive care unit. For the overwhelming majority of patients with uncomplicated intoxication, the prognosis remains favorable.