Toxicology Rounds: Look Out for Poisonings from… : Emergency Medicine News – LWW Journals
herbal abortifacient, abortion, Dobbs v. Jackson, poisoning, Roe v. Wade:
Clockwise from top left: pennyroyal, blue cohosh, black cohosh, mugwort, rue, and Cinchona (quinine).
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Online searches for DIY abortions using herbs skyrocketed after the leak of the draft decision in Dobbs v. Jackson Women’s Health Organization, the Supreme Court case that has now overturned Roe v. Wade. (New York Times. July 11, 2022; https://nyti.ms/3zkt6ls.) The hashtags #pennyroyaltea, #mugw…….
Clockwise from top left: pennyroyal, blue cohosh, black cohosh, mugwort, rue, and Cinchona (quinine).
Figure
Online searches for DIY abortions using herbs skyrocketed after the leak of the draft decision in Dobbs v. Jackson Women’s Health Organization, the Supreme Court case that has now overturned Roe v. Wade. (New York Times. July 11, 2022; https://nyti.ms/3zkt6ls.) The hashtags #pennyroyaltea, #mugwort, and the like have become exceedingly popular, especially on TikTok.
Many of the TikTok videos promoting ancient herbal preparations as abortifacients have been taken down, but similar discussions can still be found online. We emergency physicians and medical toxicologists are likely to see more cases of exposure to and overdose from folk methods for terminating pregnancies because of the Dobbs decision.
None of these methods consistently induces abortion, and some can cause significant morbidity and even death. But it seems like a good time to review the toxicity of some of the more common herbal “abortifacients.”
Pennyroyal (Mentha pulegium)
Think of acetaminophen when you think of pennyroyal. (Mnemonic Mnote: pennyroyal ~ Tylenoyal.) Pennyroyal, like acetaminophen, is hepatotoxic, causing centrilobular necrosis in the liver. Like acetaminophen, its main toxic ingredient, pulegone, is converted to a more toxic metabolite, menthofuran, by the hepatic P450 enzyme CYP2E1. Liver damage occurs when hepatic glutathione stores are depleted, which is what also occurs with acetaminophen.
Pennyroyal is a perennial bush in the mint family with distinctive purple flowers. It is native to the Mediterranean region but now widely distributed. It has been used since ancient times to induce abortion, treat headache and excessive flatulence, and repel insects.
This herb is probably best known from the Nirvana song “Pennyroyal Tea,” in which Kurt Cobain sings: “Sit and drink Pennyroyal tea / Distill the life that’s inside of me / Sit and drink Pennyroyal Tea / I’m anemic royalty.”
Early signs and symptoms of pennyroyal toxicity include nausea and vomiting, abdominal pain, and dizziness. Chemical hepatitis with elevated levels of AST and ALT starts within 24 hours of ingestion. This is followed by true liver dysfunction manifested as coagulopathy, renal failure, seizures, and, in rare cases, death in significant exposures. The essential oil is much more concentrated and toxic than the leaves of the plant or the tea made from them.
Treatment of pennyroyal toxicity involves supportive care. Because pennyroyal causes effects similar to those of acetaminophen, administrating N-acetylcysteine would be a reasonable intervention. Many of the adverse effects of pennyroyal are the result of P450 metabolism, and it is a fascinating but unresolved question …….
