Bufotoxin

Bufotoxins are a family of toxic steroid lactones or substituted tryptamines of which some are toxic. They occur in the parotoid glands, skin, and poison of many toads (Bufonidae family) and other amphibians, and in some plants and mushrooms.[1][2][3] The exact composition varies greatly with the specific source of the toxin. It can contain 5-MeO-DMT, bufagins, bufalin, bufotalin, bufotenin, bufothionine, dehydrobufotenine, epinephrine, norepinephrine, and serotonin. Some authors have also used the term bufotoxin to describe the conjugate of a bufagin with suberylarginine.[4]

Chemical structure of one of the main components of bufotoxin, a conjugate of bufagin with suberylarginine. This component is itself sometimes called bufotoxin.

The toxic substances found in toads can be divided by chemical structure in two groups:

  1. bufadienolides, which are cardiac glycosides (e.g., bufotalin, bufogenin)
  2. tryptamine-related substances (e.g., bufotenin)

Toads known to secrete bufotoxin include the following:

Extraction

Extract from the skin of certain Asian toads, such as Bufo bufo gargarizans and Bufo melanostictus, is often found in certain Chinese folk remedies. The Pharmacopoeia of the People's Republic of China (ChP) considers the two species valid sources of toad venom (Chinese: 蟾酥; pinyin: Chánsū; Latin: bufonis venenum), and requires the dry product to contain at least 6% of cinobufagin and resibufogenin combined by weight. The extract is obtained by squeezing the parotoid glands of caught, washed toads for a white venom and drying; the final dried venom is usually brown, with a chunk or flake form.[5]

Human poisoning

Toad‐venom poisoning is rare but can kill.[6] It can occur when someone drinks toad soup, eats toad meat or toad eggs, or swallows live toads on a bet.[6][7] It can also happen when someone deliberately takes commercial substances made with toad toxins.[7] These go under names including "Kyushin", "Chan Su" (marketed as a painkiller,[7] topical anesthetic or cardiac treatment[8]), "Rockhard" and "Love Stone" (marketed as aphrodisiacs).[7]

"Chan Su" (literally "toad venom") is often adulterated with standard painkillers, such as paracetamol, promethazine and diclofenac. It may be ingested or injected.[9]

Symptoms of Intoxication

Symptoms may vary depending on certain factors such as the size and age of the victim. Other than the first, more benign symptoms (such as a tingling or burning sensation in the eyes, mucus membranes, or in exposed wounds), the most frequently described symptoms in the medical literature are :

One epileptic episode caused by Bufotoxins was observed in a 5-year old child, minutes after they had placed a Bufo alvarius in their mouth. The child was successfully treated with diazepam and phenobarbital. [10]

In extreme cases following ingestion of mucus or skin of the toad, death generally occurs within 6 and 24 hours. Victims surviving past 24 hours generally will recover.

References
  1. Siperstein MD, Murray AW, Titus E (March 1957). "Biosynthesis of cardiotonic sterols from cholesterol in the toad, Bufo marinus". Archives of Biochemistry and Biophysics. 67 (1): 154–60. doi:10.1016/0003-9861(57)90254-0. PMID 13412129.
  2. Lincoff, Gary; Mitchel, Duane H. (1977). Toxic and Hallucinogenic Mushroom Poisoning: A Handbook for Physicians and Mushroom Hunters. New York: Van Nostrand Reinhold. ISBN 978-0-442-24580-1.
  3. Kißmer, B.; Wichtl, M. (1986). "Bufadienolide aus Samen von Helleborus odorus" [Bufadienolides from the Seeds of Helleborus odorus]. Planta Medica (in German). 52 (2): 152–3. doi:10.1055/s-2007-969103. S2CID 84240708.
  4. Chen KK, Kovaríková A (December 1967). "Pharmacology and toxicology of toad venom". Journal of Pharmaceutical Sciences. 56 (12): 1535–41. doi:10.1002/jps.2600561202. PMID 4871915.
  5. 国家药典委员会 (2015). 中华人民共和国药典 [Pharmacopoeia of the People's Republic of China] (in Chinese). Vol. 1 (10 ed.). 中国医药科技出版社. p. 333. ISBN 9787506773379. entries: 蟾酥 bufonis venenum
  6. Kuo, HY; Hsu, CW; Chen, JH; Wu, YL; Shen, YS (March 2007). "Life-threatening episode after ingestion of toad eggs: a case report with literature review". Emergency Medicine Journal. 24 (3): 215–6. doi:10.1136/emj.2006.044602. PMC 2660035. PMID 17351232.
  7. Cartwright, Megan (29 June 2015). "These Men Died Trying to Achieve Epic Erections". Slate Magazine. Retrieved 22 April 2021.
  8. Kostakis, Chris; Byard, Roger W. (2009-07-01). "Sudden death associated with intravenous injection of toad extract". Forensic Science International. 188 (1): e1–e5. doi:10.1016/j.forsciint.2009.02.006. ISSN 0379-0738. PMID 19303230.
  9. Trakulsrichai, S; Chumvanichaya, K; Sriapha, C; Tongpoo, A; Wananukul, W (2020). "Toad Poisoning: Clinical Characteristics and Outcomes". Therapeutics and Clinical Risk Management. 16: 1235–1241. doi:10.2147/TCRM.S272863. PMC 7752649. PMID 33363378.
  10. Hitt M, Ettinger DD. Toad toxicity. N Engl J Med ; 1986 ; 314:1517
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