Question 1

How does Cerbera manghas cause cardiac toxicity?

Accepted Answer

Cerbera manghas contains potent cardiac glycosides, primarily cerberin, which inhibit the sodium-potassium ATPase pump in cardiac cells. This inhibition increases intracellular calcium concentration, initially strengthening cardiac contractions but ultimately disrupting normal electrical conduction. The result is severe cardiac arrhythmias that can progress to complete heart block and cardiac arrest. Unlike pharmaceutical cardiac glycosides such as digoxin, cerberin has an extremely narrow margin between therapeutic and lethal doses, making the plant highly dangerous (Evidence level: C).

Question 2

Is Cerbera manghas safe to use during pregnancy?

Accepted Answer

No, Cerbera manghas is absolutely unsafe during pregnancy and breastfeeding. The cardiac glycosides present in all plant parts, including cerberin and neriine, can cross the placental barrier and may cause fetal cardiac arrhythmias, miscarriage, or stillbirth. These compounds can also pass into breast milk, posing serious risks to nursing infants. Given the well-documented potential for fatal cardiac toxicity in adults, pregnant and breastfeeding women must avoid any exposure to this plant (Evidence level: C, based on cardiac glycoside pharmacology).

Question 3

What is the safe dosage of Cerbera manghas for medicinal use?

Accepted Answer

There is no established safe dosage for Cerbera manghas. All parts of the plant contain potentially lethal concentrations of cardiac glycosides, and no clinical trials have determined a therapeutic window. Traditional folk medicine used bark preparations topically for skin conditions, but even external application carries risk of systemic absorption through damaged skin. Self-medication with this plant is strongly contraindicated by medical herbalists and toxicologists alike. Internal consumption has caused fatal poisonings (Evidence level: C, Traditional).

Question 4

Does Cerbera manghas interact with heart medications like digoxin?

Accepted Answer

Yes, Cerbera manghas poses severe and potentially fatal interaction risks with cardiac medications. Its cardiac glycosides can cause additive toxicity when combined with digoxin, other cardiac glycoside drugs, beta-blockers, calcium channel blockers, or antiarrhythmic medications. Concurrent use with diuretics may worsen electrolyte imbalances that increase cardiac glycoside toxicity. Patients taking any heart medications must strictly avoid this plant. The combination can precipitate life-threatening arrhythmias even at exposure levels that might otherwise be tolerated (Evidence level: C).

Question 5

What happens if someone ingests Cerbera manghas leaves or fruit?

Accepted Answer

Ingestion of any part of Cerbera manghas is a medical emergency requiring immediate hospital care. Symptoms typically begin within 1-2 hours and include severe vomiting, abdominal pain, diarrhea, dizziness, and visual disturbances. Cardiac effects follow, including bradycardia, heart block, and potentially fatal arrhythmias leading to cardiac arrest. The fruit, sometimes called 'sea mango,' resembles a small mango and has caused accidental poisonings. There is no specific antidote; treatment involves supportive care, activated charcoal if early, and cardiac monitoring (Evidence level: C, based on case reports).

Cerbera manghas

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