Multiple organ dysfunction and rhabdomyolysis associated with moonwort poisoning: Report of four cases

Table 1 Patients’ characteristics

Case	Age (yr)	Weight (kg)	Past medical history	Time since poisoning to symptoms, h	Dose of herbal liquid and medicine
Case 1	64	65	No	6	200 mL + 20 g
Case 2	60	51	Hypertension	6	150 mL + 10 g
Case 3	36	53	No	2	450 mL + 40 g
Case 4	7	28	No	4	100 mL + 10 g

Table 2 Vital signs on physical examination at admission to our emergency room

Case	Blood pressure (mmHg)	Pulse (beats/min)	Respiratory rate (breaths/min)	Temperature (ºC)	SpO2 (%)
Case 1	114/69	93	19	36	96
Case 2	167/77	92	26	37	99
Case 3	138/97	110	28	36.2	95
Case 4	124/80	109	24	37.2	98

SpO₂: Peripheral capillary oxygen saturation.

Table 3 Results of laboratory investigations after admission

	Case	Day1 1	Day1 1 after treatment2	Day1 2 after treatment2	Day1 7
K+, mmol/L	Case 1	3.95	4.29	3.39	4.23
	Case 2	2.93	3.02	2.82	3.59
	Case 3	3.33	3.72	3.33	4.33
	Case 4	3.57	3.77	3.22	4.09
Ca2+, mmol/L	Case 1	2.06	2.01	1.97	2.2
	Case 2	2.11	1.96	1.98	2.19
	Case 3	2.08	2.02	2.05	2.27
	Case 4	2.27	2.17	2.19	2.39
Na+, mmol/L	Case 1	140.5	138.1	139.3	138.4
	Case 2	136.1	141	144.8	146.6
	Case 3	140.3	138.3	143.9	144.8
	Case 4	141.6	140.8	138.9	140.9
Cl-, mmol/L	Case 1	106	103.2	109.6	102.3
	Case 2	103.4	108.5	113	105
	Case 3	106	103.2	111.7	104.2
	Case 4	100	104.6	100.3	99.1
Cardiac troponin I, ng/mL	Case 1	0.26	0.14	0.06	0.03
	Case 2	0.44	0.32	0.04	0.01
	Case 3	1.26	0.62	0.1	0.04
	Case 4	0.94	0.48	0.08	0.03
Myoglobin, ng/mL	Case 1	> 1000	316.3	102	68
	Case 2	> 1000	229	85	57
	Case 3	> 1000	468.7	70	55
	Case 4	225.5	225.5	40	29
Creatine kinase isoenzyme, ng/mL	Case 1	> 500	318.8	40.8	2
	Case 2	155.8	84.1	11.2	3.4
	Case 3	> 500	171.2	41.4	2.6
	Case 4	489.5	489.5	116.6	3.07
Creatine kinase, U/L	Case 1	47643	30233	30028	69
	Case 2	7039	5101	2796	86
	Case 3	42251	28228	13446	112
	Case 4	19350	5814	1458	58
White blood cell count, 109/L	Case 1	11.17	12.41	15.23	9.05
	Case 2	13.14	13.03	12.93	9.38
	Case 3	15.14	13.68	14	9.11
	Case 4	11.22	10.67	11.74	6.92
Neutrophil count, 109/L	Case 1	9.39	11.82	13.71	6.2
	Case 2	10.56	12.14	11.51	6.26
	Case 3	13.11	12.91	13.16	6.07
	Case 4	8.54	9.43	8.85	4.69
Lymphocyte count, 109/L	Case 1	1.37	0.58	1.13	1.27
	Case 2	1.71	0.63	1.06	2.66
	Case 3	1.59	0.7	0.69	1.68
	Case 4	1.99	1	1.84	1.61
Monocyte count, 109/L	Case 1	0.37	0.01	0.38	0.39
	Case 2	0.86	0.26	0.35	0.52
	Case 3	0.4	0.07	0.14	0.58
	Case 4	0.62	0.21	1.02	0.57
Eosinophilic granulocyte count, 109/L	Case 1	0.03	0	0	0
	Case 2	0.01	0	0	0
	Case 3	0.04	0	0.01	0.02
	Case 4	0.04	0.01	0.01	0.03
Basophilic granulocyte count, 109/L	Case 1	0.01	0	0.01	0.01
	Case 2	0	0	0.01	0.01
	Case 3	0	0	0	0.01
	Case 4	0.03	0.02	0.02	0.02
Red blood cell count, 109/L	Case 1	5.3	4.97	4.71	4.66
	Case 2	5.06	4.85	4.58	4.04
	Case 3	4.88	4.75	4.66	4
	Case 4	4.94	4.99	4.57	4.7
Blood platelet count, 109/L	Case 1	264	185	111	127
	Case 2	178	135	108	132
	Case 3	404	320	258	273
	Case 4	364	335	313	266
Hemoglobin, g/L	Case 1	163	154	145	141
	Case 2	148	145	136	121
	Case 3	116	113	111	117
	Case 4	135	135	125	137

¹The day in our hospital.

²Two hours after hemoperfusion/plasma exchange.

Table 4 Type and time of blood purification

Date	Case	Type	Time (h)
2018.10.231	Case 1	Hemoperfusion	2
	Case 2	Hemoperfusion	2
	Case 3	Hemoperfusion	2
	Case 4	Plasma exchange	2
2018.10.242	Case 1	Hemoperfusion	2
	Case 2	Hemoperfusion	2
	Case 3	Hemoperfusion	2
	Case 4	Plasma exchange	2

¹The second day after poisoning.

²The third day after poisoning.