SHM Converge Scientific Abstract ePoster Gallery-Good Gourd! An Unexpected Cause of Shock

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This case describes a rare cause of distributive shock from cucurbitacin poisoning, also called “toxic squash syndrome.” Cucurbitacins are bitter, toxic compounds found in gourds and squash, especially when poor cultivation or cross-pollination produces inedible fruit. There is no specific test for the toxin, so diagnosis depends on careful history, ruling out other causes, and improvement with supportive care.<br /><br />A 47-year-old man with hypertension developed severe nausea, vomiting, and bloody diarrhea about 30 minutes after drinking raw homemade bottle gourd juice. He first presented to urgent care pale, diaphoretic, and hypotensive, then deteriorated in the emergency department with altered mental status and transient loss of consciousness. Because of shock, he was treated initially for possible sepsis with IV fluids and broad-spectrum antibiotics and transferred to the ICU.<br /><br />His labs showed marked lactic acidosis, acute kidney injury, elevated liver enzymes, electrolyte abnormalities, and severe metabolic derangement. CT imaging showed thickened small bowel and a decompressed inferior vena cava, suggesting hypovolemia/shock. Cultures, hepatitis testing, and respiratory viral panel were negative, and surgical causes such as cholecystitis or cholangitis were excluded.<br /><br />Further history revealed the key clue: ingestion of an extremely bitter bottle gourd drink. The concentrated raw juice likely delivered a high dose of cucurbitacins, causing rapid gastrointestinal symptoms and shock. He improved with aggressive supportive care, including fluids and electrolyte correction, and later returned to normal vital signs and laboratory values before discharge.<br /><br />The report emphasizes the importance of obtaining a detailed dietary history, especially in culturally diverse populations where bottle gourd may be used as a health food.

Asset Subtitle

Valerie Renard

Meta Tag

Author List Kathleen Batley, Valerie Renard

Category Clinical Vignettes

Concept Cucurbitacin

Concept Distributive Shock

Concept Supportive Management

Concept Fluid Resuscitation

Concept Gastrointestinal Symptom

Distinguished Finalist

Presenter Organization Duke University

Presenting Author Valerie Renard

Track Adult

Keywords

cucurbitacin poisoning

toxic squash syndrome

bottle gourd juice

distributive shock

hypotension

gastrointestinal toxicity

lactic acidosis

acute kidney injury

supportive care

dietary history

Cucurbitacin

Distributive Shock

Supportive Management

Fluid Resuscitation

Gastrointestinal Symptom