Clinical characteristics and predictors of severe toxicity following acute rotundine poisoning: A retrospective study of 37 patients in Vietnam.

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Original abstract

<h4>Background</h4>Rotundine (L-tetrahydropalmatine) is widely used in Vietnam as an over-the-counter sedative and sleep aid. However, clinical data regarding acute Rotundine poisoning remain scarce. This study aimed to characterize the clinical manifestations, management, outcomes, and predictors of severe toxicity in patients with acute Rotundine poisoning.<h4>Methods</h4>We conducted a retrospective observational study of consecutive patients with acute Rotundine poisoning admitted to the Emergency and Poison Control Department, Thai Nguyen University of Medicine and Pharmacy Hospital, Vietnam, between April 2024 and June 2026. Demographic characteristics, clinical manifestations, laboratory findings, electrocardiographic abnormalities, treatment, and outcomes were analyzed.<h4>Results</h4>Thirty-seven patients were included. The median age was 27 years (IQR 21-41.5), and 56.8% were female. Central nervous system depression was the predominant clinical manifestation, with severe impairment of consciousness (GCS <8) occurring in 5.4% of patients. QTc prolongation (≥440 ms) was observed in 16.2%. Four patients (10.8%) required mechanical ventilation and intensive care admission. Admission GCS demonstrated excellent predictive performance for mechanical ventilation (AUC 0.989, 95% CI 0.959-1.000), with an optimal cutoff value of ≤ 12 (sensitivity 100%, specificity 97.0%). No deaths occurred.<h4>Conclusions</h4>Acute Rotundine poisoning generally has a favorable prognosis but may occasionally cause severe central nervous system depression requiring intensive care and mechanical ventilation. Admission GCS may serve as a simple bedside predictor of severe toxicity, while electrocardiographic monitoring should be considered because QTc prolongation is relatively common.

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