Toxic Squash Syndrome
The Cucurbitaceae (also called cucurbits or the “gourd family”) are a family of plants consisting of approximately 965 species. The plants in the gourd family we’re most familiar with include squash, pumpkin, zucchini, melons, & cucumber.
Bottle gourd (Lagenaria siceraria) is an edible cucurbit. When bottle gourds are extremely bitter, however, ingestion can cause rapid onset diarrhea, vomiting, gastrointestinal bleeding, and hypotension due to release of a substance named cucurbitacin. Deaths in human are very rare, but have been reported.
Cucurbitacins are tetracyclic terpenes with steroidal structure. Twenty cucurbitacins have been isolated from the ~965 known species of Cucurbitaceae. A few in-vivo toxicity reports place the range of toxicity of cucurbitacins between 2 — 12.5 mg/kg.
Think you might have a patient with toxic squash syndrome? Ask the patient if the plant tasted unusually bitter. The patient may present with nausea, vomiting, and diarrhea within 5 to 25 min of ingesting cooked or uncooked plant material. Occasionally, severe diarrhea, hematemesis, and hypotension have been reported. In France, there are several cases of hair loss 1–2 weeks after the ingestion.
Patients improve with supportive care within a few days with intravenous fluids and proton pump inhibitors. Call the Washington Poison Center for treatment assistance: 1–800–222–1222.
Learn more about toxic squash syndrome:
DOI: 10.1016/j.jemermed.2013.08.106
DOI: 10.4103/0973–7847.156314
