Watermelon poisoning in adults and children

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

The characteristic flavour of watermelon is due to medium and short chain fatty acids, geranial, ß-ionone and neral. Its consumption has increased due to its rich nutritional composition and associated health benefits. It is effective in reducing the incidence of cancer, cardiovascular diseases, [ 1 ] diabetes and macular diseases. Considering the nutritional profile, consumption of 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 fibre. It is enriched with carotenoid, vitamin C, citrulline, carotenoids and flavonoids, contains no fat 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 of vitamin A. In addition to lycopene, it is a source of B vitamins, especially B1 and B6, and 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 is constantly on everyone's lips in the summer. Such cases happen quite often. How can you get poisoned by such a wonderful product?

Epidemiology

The exact statistics of this type of poisoning are 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 products in which they were found and multiplied.

Causes watermelon poisoning

This is mainly due to violation of the rules for growing, transporting and storing watermelons. You cannot get poisoned by a good quality watermelon. Poisoning in most cases occurs due to the excess content of nitric acid mineral substances in it due to the fact that the watermelon is grown in soil generously fertilized with saltpeter. Nitrates, which are 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 everywhere in small quantities, including living organisms and soil. They are a necessary component of metabolic processes, but their use often exceeds permissible standards. Agricultural producers pursue their goal - increasing crop yields. Intensive fertilization of plants with saltpeter promotes earlier ripening of fruits. Therefore, it is most dangerous to buy watermelons that appear on the shelves at the beginning of summer. They are certainly grown on richly fertilized soils. [ 3 ]

Even with moderate use of fertilizers, there are risk factors for the accumulation of excess nitrates in produce and in the body. The first include regular annual fertilization of the soil, which promotes its mineralization, and drought. The second is the regular consumption of watermelons with moderate nitrate content by people with insufficient methemoglobin reductase activity. They gradually develop chronic poisoning. At risk are infants and small children, as well as the elderly. [ 4 ]

Pathogenesis

The pathogenesis of nitrate poisoning begins with the ingestion of fertilizer-rich watermelon into the digestive tract. 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 ]

It is not only nitrates that can cause poisoning; a watermelon can be clean in this regard, but damaged – bruised, cracked, crushed, overripe. In such cases, pathogenic microorganisms begin to actively multiply in the sweet pulp of the watermelon. Also, pathogens of intestinal infections from poorly washed watermelon rind or from unwashed hands can get onto 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 scales to demonstrate its degree of ripeness. [ 7 ]

How long does it take for watermelon poisoning to manifest? It depends on many factors: 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 for “dirty hands diseases” can last several hours, and is often a day or more, so sometimes poisoning is no longer associated with eating a watermelon cut with a dirty knife. [ 8 ]

Symptoms watermelon poisoning

Whatever the cause of poisoning after eating watermelon, the first signs will look like the body's attempts to get rid of the toxic substance - nausea and vomiting will appear to eliminate the inappropriate contents of the stomach, diarrhea - as a means of cleansing the intestines, pain and rumbling in the epigastrium and / or lower abdomen. The presence and strength of other manifestations of intoxication will correspond to the amount eaten and the type of toxic substance in the watermelon.

The symptoms of watermelon poisoning in adults and children are not very different, it's just that a child's body reacts to the ingestion of much smaller amounts of toxins. That's why there are situations when everyone ate the watermelon, but only one person suffered. Often, this is a small child or an elderly person. [ 9 ]

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

Nitrate poisoning from watermelon manifests itself in the same way as a bacterial infection, but with high levels of nitrates, metoglobinemia and tissue hypoxia develop. Neurological symptoms appear - the patient feels dizzy, there is a ringing in the 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 side under the rib (in the liver area), some people experience yellowing of the sclera of the eyes and skin. He becomes drowsy, consciousness may be confused, mental depression or, conversely, an abnormally excited state may be observed. The state of health becomes increasingly worse - breathing and heart function are impaired, 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 shade, and the mucous membranes become dark blue. In a mild degree, there may be no other pronounced symptoms, except for increased fatigue, which is often not associated with the consumption of watermelon.

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

Poisoning from an old watermelon manifests itself with the symptoms listed above. However, the term "old" is not quite correct. Apparently, it means a spoiled fruit - with a sour, spoiled, flabby pulp. Bacterial flora is already multiplying in such a watermelon, and eating it is, at the very least, unwise - the outcome is predetermined. It is better to throw it away.

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

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

The proliferation of these same pathogens in the small intestine can cause symptoms of acute enteritis syndrome. The stomach rumbles, and cramping pains are felt periodically in different places. Severe diarrhea is typical. The stool is abundant, watery and light, often with foam and lumps of undigested food.

Spasmodic pain in the lower abdomen, more often on the left, accompanied by tenesmus, frequent urge to defecate, scanty stool with a feeling of incomplete emptying of the intestines indicate acute colitis. Flatulence and rumbling are characteristic. The frequency of visits to the toilet can reach 25 times a day. The stool is initially abundant and foul-smelling, eventually becoming 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 intestinal inflammation is dehydration.

Watermelon poisoning during pregnancy

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

However, if a woman in an “interesting” position feels unwell after eating watermelon, she should not delay seeking medical help. Watermelon poisoning in a pregnant woman has the same symptoms as in everyone else. During pregnancy, it is dangerous for both. Pregnant women can quickly become dehydrated due to frequent vomiting and diarrhea. Women with a history of varicose veins are at risk of developing thrombosis as an undesirable consequence of water deficiency 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 spontaneous abortion or premature birth. [ 15 ]

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

Due to all these consequences, pregnant women should be picky when choosing watermelons and buy them only in season (August-September).

Watermelon poisoning during breastfeeding

It is preferable for a baby that its nursing mother is poisoned by an old and sour watermelon, that is, in case of ordinary, not too severe food poisoning, you can even continue breastfeeding. Pathogens of intestinal infections affect the lower parts of the woman's digestive system, and the penetration of the 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 require antibiotic therapy and hospitalization, then the child is not in danger, and there is no need to deprive him of natural feeding. [ 16 ]

Much more dangerous for a child is poisoning with nitrate watermelon. Nitric acid salts penetrate well into breast milk. And children in the first year of life are much more prone to the development of methemoglobinemia than adults. Their endogenous regulatory mechanism is still imperfect. The enzyme methemoglobin reductase in infants up to four months does not yet work at full capacity, the intestinal microbiocenosis also contributes to the formation of this dangerous compound. Even hemoglobin in newborns is of the fetal type, which oxidizes much better than in an adult. Therefore, a child, especially in the first months of life, can be fatally poisoned by nitrates received through breast milk. [ 17 ], [ 18 ]

The clinical picture of poisoning in infants differs from adult manifestations. Vomiting and diarrhea may not be observed. The child will become lethargic and drowsy, and may experience shortness of breath, cyanosis, and convulsions. [ 19 ], [ 20 ]

Watermelon poisoning in children

As a result of eating a 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 age of the child and his individual sensitivity.

Food poisoning is more likely to manifest itself as abdominal pain, vomiting and diarrhea against a background of weakness and, possibly, high fever.

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

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

If symptoms of illness appear in a child within two to six hours after eating watermelon, and they worsen, you should seek medical help without delay.

Complications and consequences

Mild watermelon poisoning usually does not require hospitalization and passes without consequences.

Severe poisoning, especially associated with high nitrate levels, can be complicated by allergic reactions, inflammatory processes in the liver or pancreas, dehydration and, as a result, disruption of almost any type of metabolic processes. Any organs can be affected, especially if a person suffers from a chronic disease. Watermelon poisoning can cause its exacerbation. [ 22 ]

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

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

Diagnostics watermelon poisoning

To effectively treat watermelon poisoning, it is necessary to determine what toxic agent caused it. Blood tests are mandatory - clinical, biochemical and hemoglobin fractions. An experienced laboratory technician can already determine methemoglobinemia when taking blood - the blood acquires a brownish-brown tint. Stool culture or more modern methods - PCR, enzyme immunoassays will help to identify the causative agent of intestinal infection.

A general urine analysis will determine how the kidneys are functioning. If liver damage is suspected, liver function tests are prescribed. In cases of severe poisoning with complications, instrumental diagnostics are prescribed as indicated. [ 27 ]

Differential diagnosis

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

Treatment watermelon poisoning

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

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

You need to drink a lot of liquid at one time, four to six glasses for an adult. Then induce vomiting and repeat the procedure until clean water starts coming out of the stomach. It is better not to do this procedure for small children. It is also contraindicated if the victim is in a semi-fainting state.

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

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

Any home medicine cabinet usually contains activated carbon. This is the most primitive sorbent. It absorbs everything - both useful substances and toxic ones. However, if there is nothing else in the medicine cabinet, then it will do just fine. It is taken at the rate of one tablet per ten kilograms of the victim's weight. For greater effect, it is recommended to crush the tablets and mix them with a small amount of water, then drink the carbon suspension.

More modern products of this group Enterosgel, Atoxil, Polysorb are based on silicon. They absorb toxic substances, pathogenic microorganisms and their metabolic products from the stomach and intestinal contents. In addition, absorption 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 methylsilicic acid in the form of a hydrogel, completely ready for use. Atoxil and Polysorb are produced in the form of highly dispersed silicon dioxide 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 beneficial microflora, helps restore smooth muscle tone and normalize peristalsis. Absorbed toxic substances and the hydrogel itself are eliminated from the body with feces. Sorbents do not penetrate into the systemic bloodstream. They have virtually no contraindications or side effects. [ 30 ]

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

The victim needs to drink plenty of clean water. In case of frequent vomiting and severe diarrhea, rehydration therapy may be necessary. In such cases, Regidron is used, which contains table salt, glucose, sodium and potassium salts. The packet is dissolved in a liter of boiled water and given to the patient to drink after each loss of fluid.

The victim, who has lost a lot of fluid 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 necessary vitamins and minerals. A special diet after watermelon poisoning is not required, although it is necessary to adhere to the principles of fractional nutrition (eat small portions and often), avoid fatty, fried foods, an abundance of confectionery and fresh pastries. In case of complications in internal organs, the attending physician will individually advise what diet to follow. For example, if the kidneys are affected, it is recommended to eat unsalted food, in case of liver damage, table No. 5 is recommended. [ 31 ]

In mild cases of watermelon poisoning, home treatment may help. However, if home detoxification does not provide relief, it is imperative to seek professional help. The patient may require resuscitation measures aimed at ensuring respiratory and cardiac functions, therapy to support liver and kidney function, and blood circulation. In cases of nitrate poisoning and severe 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 setting by intravenous administration of methylthioninium chloride.

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

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

Gastric lavage is the main first aid procedure, which is unanimously recommended by all branches of medicine - both folk and homeopathy. Moreover, the same clean water or solutions of soda, potassium permanganate or salt are used. The salt solution itself causes a gag reflex in many people. There is no need to even induce vomiting. Enemas are actively used to cleanse the lower intestines. The solution is made in proportions - a tablespoon of regular table or sea salt per liter of water at body temperature.

Traditional treatment of poisoning begins after washing the stomach. Cinnamon drink is considered an antidote for poisonous nitrogenous substances. It is prepared as follows: 3-4 cinnamon sticks are poured with water (500 ml), brought to a boil and boiled for about five minutes. Then the decoction is cooled slightly (3-5 minutes) and filtered. Drink while it is still warm, in two or three doses.

Traditional healers recommend not to lie flat out in case of poisoning, but to move. After washing the stomach and intestines, the absorbed toxic substances are also excreted through the skin. Movement stimulates this route of excretion, in addition, wet rubbing, baths, showers, visits to the bathhouse and sauna are used for detoxification. Naturally, if the patient is in a semi-fainting state, then such methods of treatment should not be resorted to. [ 32 ]

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

At the recovery stage, herbal treatment is used. The victim is given a decoction of valerian root, a mixture of yarrow and wormwood, horse sorrel roots, infusions of chamomile flowers, calamus or dill seeds to drink. A teaspoon of honey can be added to the infusions and decoctions.

After poisoning, the patient should drink a lot - clean water, tea: ginger, green, black, but it is better to refrain from eating for the first day, and then stick to a gentle diet (liquid dishes, slimy porridge).

After gastric lavage, homeopathic preparations can be used to help neutralize the undesirable effects of watermelon poisoning and get the victim back on his feet fairly quickly. The main remedy for bacterial poisoning is Arsenicum album, Nux vomica and China are also used. In case of nitrate poisoning, their elimination can be accelerated by the preparations Acidum nitricum, Argentum nitricum, Kalium nitricum.

Complex homeopathic preparations Nux Vomica Gomacord, Gastricumel, Galium Heel, Coenzyme compositum can help the body cope with intoxication faster and avoid complications from the digestive organs, circulatory system and nervous system.

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

Prevention

Watermelons are plants that absorb fertilizers from the soil well. Therefore, they should be bought and eaten only in season, that is, in August-September. You need to choose ripe watermelons, without dents, with an undamaged rind. It should be firm, not matte, but glossy, strong (it is difficult to puncture it with a fingernail). After tapping on the rind of the watermelon, a hollow sound should be heard. The spot where the watermelon lay on the ground is yellow in a ripe fruit, not white. When buying, do not determine ripeness by cutting, this is associated with the risk of poisoning.

At home, the watermelon rind should be thoroughly washed with soap, dried and only then cut. The cut watermelon should not contain dense yellow veins, as nitrates have accumulated in them. Do not eat the watermelon slice down to the green rind, leave a little pink flesh on it. It is under the rind that the most nitrogen compounds accumulate.

It is recommended to grind a piece of watermelon in a glass cup with water. It should not turn pink. If the watermelon is normal, the water will simply become cloudy-whitish.

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

Pregnant women, nursing mothers and the elderly should exercise restraint when consuming watermelon, and children should also consume it in limited quantities.

Forecast

In the vast majority of cases, people do not die from watermelon poisoning; moreover, such troubles are often dealt with at home, which is facilitated by modern enterosorbent drugs. Timely treatment at a medical institution in severe cases of poisoning also allows you to save the lives of the victims. Nevertheless, you need to be a little careful with this tasty and healthy giant berry.