diospyros and Hypertension

Diospyros rhodocalyx (Tako-Na) is a Thai folk medicine purported to promote longevity, treat impotence, etc. We present patients with hypokalemia, weakness and hypertension after consuming Tako-Na tea.. Case 1: A 61-year-old man was brought in nine hours after drinking 400-500 mL of Tako-Na tea. One handful of Tako-Na bark was boiled in water to make tea. He had vomiting and watery diarrhea six hours after drinking it. He took no medications and had no history of hypertension. The only remarkable vital sign was BP 167/90 mmHg. Physical examination revealed generalized muscle weakness. Laboratory findings were potassium 2.7 mmol/L, bicarbonate 24 mmol/L, and transtubular potassium gradient (TTKG) 5.6. He was discharged the next day with a BP 140/90 mmHg and potassium 4.2 mmol/L. Case 2: A 78-year-old man, a friend of case 1, also drank Tako-Na tea from the same pot at the same time as case 1. He also had vomiting and diarrhea six hours later. He took no medications despite past history of hypertension (baseline SBP 140-160). Initial BP was 230/70 mmHg. He also had muscle weakness. Laboratory findings were potassium 3.3 mmol/L, bicarbonate 24 mmol/L, TTKG 7.37 and normal thyroid function. He was also discharged the next day with a BP 148/70 mmHg and potassium 4.2 mmol/L. Case 3-7: These were patients reported to a poison center and their potassium concentrations were 1.4, 1.4, 3.3, 1.3 and 1.2 mmol/L, respectively. Three of them were intubated and case 3 died.. Tako-Na contains betulin, betulinic acid, taraxerone, lupeol, and lupenone. Their structures are similar to glycyrrhetic acid, the active metabolite of glycyrrhizic acid found in licorice which is well known to cause pseudoaldosteronism. Glycyrrhetic acid is potent in inhibiting 11-beta-hydroxysteroid dehydrogenase, and causes pseudoaldosteronism. We hypothesize that the compounds in Tako-Na act in the same way as glycyrrhetic acid in producing pseudoaldosteronism.

Topics: Aged; Biomarkers; Blood Pressure; Diospyros; Electrocardiography; Female; Heart Rate; Humans; Hypertension; Hypokalemia; Liddle Syndrome; Male; Medicine, Traditional; Middle Aged; Muscle Strength; Muscle Weakness; Muscle, Skeletal; Phytotherapy; Plant Preparations; Plants, Medicinal; Potassium; Retrospective Studies; Thailand; Ventricular Premature Complexes

The antihypertensive and vasorelaxant effects of water-soluble proanthocyanidins, extracted in persimmon leaf tea, were investigated in spontaneously hypertensive rats, rat aortas, and human umbilical vein endothelial cells. Oral administration of proanthocyanidins significantly decreased the systolic blood pressure of the rats after 4 h, as compared with distilled water controls. A vasorelaxant effect on rat aortas was induced by proanthocyanidins, and it was abolished by removal of the endothelium and inhibition of endothelial nitric oxide synthase and soluble guanylyl cyclase activity. The phosphorylation levels of endothelial nitric oxide synthase (Ser-1177) and the upstream kinase Akt (Ser-473) in umbilical cells also increased in a time-dependent manner after the addition of a proanthocyanidin-rich fraction. These results suggest that the antihypertensive effect of proanthocyanidins in persimmon leaf tea is due to vasorelaxation via an endothelium-dependent nitric oxide/cGMP pathway, and that proanthocyanidins might be useful in dietary lowering of blood pressure.

Topics: Administration, Oral; Animals; Antihypertensive Agents; Aorta; Blood Pressure; Cyclic GMP; Diospyros; Endothelium, Vascular; Human Umbilical Vein Endothelial Cells; Humans; Hypertension; Male; Nitric Oxide; Nitric Oxide Synthase Type III; Phosphorylation; Phytotherapy; Plant Extracts; Plant Leaves; Proanthocyanidins; Proto-Oncogene Proteins c-akt; Rats; Rats, Inbred SHR; Solubility; Tea; Vasodilator Agents

An 87-year-old man was scheduled for cervical laminectomy. Anesthesia was maintained with nitrous oxide, oxygen, sevoflurane, and fentanyl with tracheal intubation. Thirty minutes after the start of operation, serum potassium was 7.41 mEq x l(-1). We immediately administered potassium-free fluid, furosemide, bicarbonate, calcium gluconate and insulin. We stopped the operation and returned the patient to supine position, but he fell into ventricular fibrillation. Immediate CPR and countershock successfully restored sinus rhythm within 5 minutes. He was discharged from ICU without any neurological complications. Daily he took Losartan potassium, an AIIA, due to hypertension and ate preoperatively dried persimmons, a potassium-rich food. We suspect that hyperkalemia was induced by administration of an AIIA in combination with excessive intake of dried persimmons. AIIA may cause severe hyperkalemia inhibiting aldosterone activity. We should pay attention to the serum potassium level and a preoperative intake of food especially in a patient medicated with an AIIA.

Topics: Aged; Aged, 80 and over; Angiotensin Receptor Antagonists; Antihypertensive Agents; Diospyros; Heart Arrest; Humans; Hyperkalemia; Hypertension; Intraoperative Complications; Laminectomy; Losartan; Male

The crude drug "kaki-yô" is a traditional medicine used in Japan as a hypotensive drug.. The effect of five triterpenoid compounds, isolated from leaves of Diospyros kaki on stimulus-induced superoxide generation and phosphorylation of tyrosine residues of protein in human neutrophils was investigated. The five compounds examined were alpha-amyrin (A), uvaol (UV), ursolic acid (UA), 19 alpha-hydroxy ursolic acid (HU) and 19 alpha,24-dihydroxy ursolic acid (DHU).. When the cells were preincubated with these compounds, the superoxide generation induced by N-formyl-methionyl-leucyl-phenylalanine (fMLP) was significantly suppressed in a concentration-dependent manner. These compounds also suppressed the superoxide generation induced by arachidonic acid (AA) in high concentrations. In the case of the superoxide generation induced by phorbol 12-myristate 13-acetate (PMA), UA, HU and DHU suppressed the superoxide generation but A and UV gave no effect. When the cells were incubated with fMLP in UA, HU and DHU, fMLP-induced tyrosyl phosphorylation of 45 kDa proteins of the cells was dose-dependently suppressed in parallel to the suppression of fMLP-induced superoxide generation.. Triterpenoid compounds suppress stimulus-induced superoxide generation and tyrosyl phosphorylation and may have pharmaceutical applications.

Topics: Antihypertensive Agents; Cells, Cultured; Diospyros; Dose-Response Relationship, Drug; Hypertension; Japan; Medicine, Traditional; Molecular Structure; Neutrophils; Phosphorylation; Plant Leaves; Plants, Medicinal; Superoxides; Triterpenes