A 69-year-old man slipped into a coma and suffered from organ failure after consuming old coconut water. AC, a resident of Denmark, was declared brain dead hours after he was brought to the emergency room of Aarhus University Hospital, Denmark last year.
What happened to AC?
AC was admitted to Aarhus University Hospital, Aarhus, Denmark, in a state of reduced consciousness. He had consumed coconut water directly from a pre-shaved coconut using a straw about 4.5 hours before he was admitted.
He had swallowed only a small amount before he realised that the coconut was rotten. He opened the coconut to check and described to his wife that the interior was slimy and looked rotten, according to a report by US National Center for Biotechnology Information (NCBI).
The recommended storage of the coconut was 4°C-5°C in the refrigerator, but AC noted that the coconut had been kept on his kitchen table for over a month.
About three hours after drinking the coconut water, AC began to notice strange symptoms. He began sweating and soon experienced nausea and vomiting. He became unconscious and fell on the floor. His wife called for medical help. Ambulance attendants found him in distress with pale and grey skin, a reduced mental state with confusion and poor balance. However, he was able to answer questions with some delay.
AC was unconscious when he was taken to the emergency room. Several tests were performed but the results showed no abnormalities.
His pupils were partially reactive to light indicating something may be wrong with his nervous system. His blood tests indicated that he had metabolic acidosis (an increased amount of acid in the blood) which indicated that he had some abnormal metabolic activity going on.
As his condition worsened, he was shifted to the intensive care unit (ICU) two hours after his arrival at the hospital. Doctors noticed sudden jerks in his forearms and calves and his body temperature increased to 39.7°C. These symptoms indicated trouble with his brain and nervous system.
Intoxication from opioids and other substances was ruled out by tests and doctors could not determine why the patient was suffering from such symptoms.
An MRI scan was performed on AC’s brain which showed significant swelling as he suffered from brain herniation. Severe toxication due to abnormal metabolic activity was suspected.
His new blood samples revealed high levels of ammonia which indicated abnormal functioning or a total shutdown of the liver. When ammonia increases in the blood, it reaches the brain causing it to swell. As the brain is enclosed within the skull, it can only swell to an extent before causing severe damage.
As the swelling of AC’s brain worsened, his pupils were dilated and brainstem reflexes (which indicate any normal functioning of the brain) were absent. He couldn’t breathe on his own and the decision to stop treatment was taken in consultation with AC’s family. However, the reason behind AC’s death was still a mystery.
What killed AC?
According to the autopsy, bleeding in the brain was determined as the cause of death. Further analysis revealed the growth of the fungi Arthrinium saccharicola in the coconut that AC had consumed.
This genus of fungi produces lipophilic and highly toxic 3-nitropropionic acid (3-NPA), which causes severe encephalopathy (disease of the brain that alters brain function or structure).
This explained the symptoms in AC which were like those caused by bongkrekic acid.
The toxin 3-nitropropionic acid had caused poisoning in humans earlier in China and Africa, but the source of it had been sugarcane. This toxin can cause vomiting, diarrhoea and progressing encephalopathy leading to coma and death. Thus, it is important for people to be mindful of their consumption of food especially fresh produce like fruits and vegetables.
(Edited by : Sudarsanan Mani)
