Due to its laxative effects, senna (Cassia angustifolia) has been used frequently in our country and the whole world. We aimed to present a case in which a probable hepatotoxicity and death occurred because of senna used in large quantities for a long time due to its laxative effects. A sixty years old female patient admitted our emergency service with the complaints of weakness, abdominal pain and distension ongoing for about three days. She expressed that she had drunk a kind of tea made of senna for the treatment of her chronic constipation a long time and especially in the last month mostly. According to anamnesis, physical examination and investigations, we concluded that our patient may have toxic hepatitis due to consuming a large amount of senna recently for her chronic constipation. We consulted the patient to gastroenterology and organ transplantation service. She was followed for multiple organ failure, but did not respond to the interventions and died before liver transplantation. It mustn’t be forgotten that when used in an uncontrolled way, senna which is used as a laxative by people and easily reachable, can cause toxic hepatitis and also death. Case Report Turtay et al.; JAMPS, 5(2): 1-3, 2016; Article no.JAMPS.21923 2

Fatal Herb Senna: A Case Report

Constipation is one major complaint in elderly population. It may be due to physiological and anatomical reasons of aging, but it can be also due chronic medical and mental illnesses and due to use of multiple medications. Constipation itself is a precipitating factor for delirium. Drugs used for constipation can also be the culprit. A 64-year-old female who had a history of hypertension and chronic constipation presented with symptoms of confused and altered behavior, decreased oral intake, decreased sleep. On history taking it was known that she was using Herbal medication containing senna glycoside and other compounds since 8-9months. On examination she had signs of dehydration, disoriented and attention was impaired. On investigation her serum sodium was 122.6 mmol/ and other investigations were within normal limits. She was diagnosed as a case of Delirium according to ICD-10 criteria. Her dehydration was corrected by giving intravenous fluids and serum sodium level was corrected using salt capsules 2 tablets thrice daily. For disturbed sleep she was prescribed Tab Melatonin 10mg at bedtime and constipation was treated with per rectal enema and syrup lactulose 30ml at bedtime. Patient improved in 1 week time. Senna a herbal laxative used to treat constipation. It can alter intestinal electrolyte transportation and irritates intestinal mucosa. It is due to increased peristalsis and increased defecation and even diarrhea Prolonged use can cause dehydration, electrolyte imbalance and delirium. Senna, an over-the-counter laxative with FDA approval is a matter of concern in the current scenario. This case report warns into the judicious use of laxatives containing senna in elderly population.

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A Case Report of Delirium Induced by Herbal Laxative Senna

Aim Of The Study:The study aims to review depression and pain in the elderly with knee Osteoarthritis.\nMaterial And Methods: Subjects fullling selection criteria were recruited from the Department of Orthopaedics\nSurgery, KGMU, Lucknow, India.\n1. Mobile numbers of subjects from the records available were obtained from JANUARY 2018 to JANUARY 2020\n2. Topics were contacted over the telephone and recruited according to the nomination standards for the study. The call was recorded after taking\nconsent.\n3. Subjects were contacted during the daytime 10 am -2 pm.\n4. Subjects were approached three times.\n5. The survey was completed in a maximum of 2 sessions,15 minutes each (if the subject was not comfortable answering in a single session).\n6. Proper introduction of the Doctor calling them and the purpose of the telephone was given to the subjects.\n7. Telephone subjects were interviewed based on the sociodemographic questionnaire.\n8. Following the basic interview, subjects were evaluated using scales that include PHQ-9, SF-12 and WOMAC. ( Antonio Escobar, 2006)\n9. HRQoL was measured by SF-12 which includes general health, limitation of activities, physical health, emotional health and social activities.\n( MoheddineYounsi, 2015 )\n10. PHQ-9 to assess the diagnosis and severity of depression was applied.\n11. WOMAC scale was applied which gives the status of pain, stiffness and physical disabilities.\n12. Each assessment took 20-30 minutes.\n13. If subjects and attenders ask for advice regarding the treatment were addressed properly following guidance from consultants.\n14. For the subjects with depression, the advice was given to consult the geriatric mental health helpline number of KGMU. The specimen length\nassumed for this study is 90 (30 in each group in KL grade 2/3/4).\nResults: This study shows that depression was extensively observed among sufferers with knee OA. Patients with knee OA analyzed with these\ncomorbidities encountered more pain and discomfort, had systematic hospital calls, took more medication, and documented less optimal results.\nBeing a cross-sectional, telephonic survey, this study shows results accordingly.( Anirudh Sharma, et al., 2020).\nConclusion: Depression seems to have adverse impacts on the sufferers with knee OA. Physicians or caregivers are highly instructed to\ncontemplate these comorbidities in patients with knee OA. KOA studies usually comprise pain and function scores but haven't routinely\nincorporated psychosocial variables estimating QoL(Prtha Kudesia, et al., 2020). This study concludes that there is a considerable difference in\npain and general health-related quality of life (HRQoL). Pain and HRQoL worsen with higher grading of KOA. Eventually, a holistic customised\nsurveillance method is essential to enhance patient results.( Roman Sosnowski, et al., 2017).

Nimitha K J

Papers

A Case Report of Delirium Induced by Herbal Laxative Senna

Depression and pain in elderly with knee osteoarthritis pain.