MSG like food poisoning cases are of vital importance in nation like ours as we have already seen tremendous hazard in the public health due to highly advertise noddle like Mayos few decades ago. Now, there are reports of steroid and Mercury poisoning in the products prepared by Patanjali Ayurveda and marketed by Swami Ramdev. We have yet to test those products that are selling like hot cakes in Nepal.

1. FOOD POISONING
Neeraj Ojha
Om Shankar
Yuvraj Kalathoki

2. INTRODUCTION
● Food poisoning is defined as an illness caused by the
consumption of food or water contaminated with bacteria and/or
their toxins, or with parasites, viruses, or chemicals;
● Common symptoms often include vomiting, fever, and aches,
and may include diarrhea;

3. Contd.
● Food intoxication is when the food contains toxins, including
bacterially produced exotoxins, which can happen even when
the microbe that produced the toxin is no longer present or able
to cause infection;

4. Causes of food poisoning
● Bacteria and bacterial toxins:
● Viruses;
● Parasites;
● Mushrooms and toadstools;
● There are many other causes of food poisoning. These include
wild nuts, leaves, flowers and berries, underripe tubers,
botulism, cadmium from containers;

5. Sign and symptoms of food poisoning
● Abdominal pain:
● Vomiting: Major presenting symptom of S aureus, B cereus, or
Norovirus
● Diarrhea: Usually lasts less than 2 weeks
● Headache
● Fever
● Bloating
● Stool changes: Bloody or mucousy if invasion of intestinal or
colonic mucosa; profuse rice-watery;

6. Pathophysiology of food poisoning
● Although the GI tract is the primary target, autonomic nervous
system disturbances and CNS impairment are prominent
manifestations;
● Typically, FBDs in which severe vomiting (eg, staphylococcal-
toxin gastroenteritis) and small bowel diarrhea occur, typified
by Vibrio cholerae infection, can cause life-threatening
dehydration;

7. Contd.
Other organs involved include the liver in hepatitis A, muscles in
trichinosis, lymph nodes in toxoplasmosis, and, importantly, the
kidneys in hemolytic-uremic syndrome (HUS), which follows
enterohemorrhagic Escherichia coli -induced diarrhea;

8. Management
I. General management:
 Most food-borne illnesses are mild and improve without any
specific treatment. Some patients have severe disease and require
hospitalization, aggressive hydration, and antibiotic treatment;
 Preliminary ABCD treatment is recommended in any situation;

9. contd.
Supportive care:
● The main objective in managing patients with food poisoning is
adequate rehydration and electrolyte supplementation, which
can be achieved with an oral rehydration solution.

10. II. Pharmacotherapy/Specific management:
ORS therapy might be required in cases of dehydration;
Medications include:
● Antidiarrheals:
● Antibiotics: eg. Amoxicillin with clavulinate;
● Corticosteroids:eg. Methylprednisolone;
● Adrenergic agents: eg. Adrenaline;

11. Case Study
● A 23-year-old male was brought to the General Hospital at
Mahad, with complaints of difficulty in speaking, inability to
swallow saliva, and continuous spitting. He strongly rejected
taking sips of water and was afraid of water like a hydrophobic
patient. He gave no history of snake bite or ptosis. The posterior
pharynx could not be visualized, even after repeated attempts
with depression of the tongue with a spatula. The uvula and
surrounding structures, including the soft palate, were
edematous. The uvula was touching the base of the tongue;

12. Contd.
● He was weighing 80 kg, conscious cooperative and well oriented. His blood
pressure was 120/80 mmHg; pulse was 88 beats/min and regular. His
extremities were warm, the electrocardiograph was within normal limits, and
SpO2 was 98% on ambient air. The patient said that he ate only Chinese
triple fried rice for dinner the previous night 10 hours earlier. Within an hour
of eating, he had giddiness, sweating, and itching all over the body which
subsided without any medication. Two hours earlier he had woken up due to
difficulty in swallowing and speaking out a few words. He communicated
with his family with hand gestures regarding his inability to speak and
swallow. There was no history of allergy or bronchial asthma;

13. Subjective detail:
Male, Indian, 23 year old;
Hospital: General Hospital at Mahad;

14. Objective detail
● The hemoglobin was 14 mg/dl, white cell count 13,000 per cu
mm (normal 5000–10,000), eosinophils 1% (normal 1–9),
neutrophils 90.9%, random blood sugar 135 mg/dl (normal 70–
140), and serum IgE 917.021 IU/ml (normal 3–188);

15. Assessment/Diagnosis
● On arrival, swelling of the uvula and surrounding tissues, almost closing the
entry to the pharynx, touching the base of floor of the mouth;
● The patient was admitted and given intravenous crystalline solution of 40mg
methyl prednisolone and was monitored continuously for oxygen saturation;
● There was no improvement over half an hour, so 0.30 mg of adrenaline was
administered as a deep intramuscular injection over the lateral side of the
thigh. The swelling of the uvula and surroundings gradually regressed. The
patient no longer had drooling of saliva and was able to speak a few words.
His throat looked angry around the uvula and surrounding;

16. Planning:
● On account of raised leukocyte count with neutrophilia, the
patient was treated with oral Amoxycillin with clavulinate. At
16 h after the initiation of treatment, he started normal oral
communication and was able to swallow liquid.
● On the following day, there was a gradual reduction in the size
of the uvula and surrounding inflammation. 2 days from
admission, the uvula and surrounding structures including the
palate returned to normal and he could swallow solids. The
patient was then discharged with full recovery.

17. Contd.
Fig. Patient after complete
recovery;

18. Discussion
● The exact etiology of the “Chinese restaurant syndrome” is not known
but, animal studies have shown neurotoxic and neuroexcitatory
properties of MSG in the hypothalamic region of the central nervous
system. The delay of uvular swelling for > 8 h such as in our patient can
be explained by the time taken for the synthesis and release of hormonal
factors from the hypothalamic-pituitary region;
● This issue was of particular concern in Nepal too over a decade ago when
consumption of MSG in Mayos noddles produced by Khetan industries
was found to be the causative factor in several illnesses including
headache and other symptoms. Later, those produces were withdrawn