Abstract Introduction The use of complementary and alternative medicine has become increasingly prevalent in the general population due to perceived health benefits. However, these products are largely unregulated, and their intravenous use poses a variety of risks ranging from infectious to pharmacologic effects. Annona muricata (soursop) has been marketed for its antioxidant effects, and some studies have suggested potential antimicrobial effect against oral pathogens. While reports of systemic toxicity following oral ingestion exist, intravenous administration of soursop extract remains virtually undocumented. Case 61-year-old man with a history of chronic constipation presented to the emergency department after self-administering 4ml of soursop herbal extract intravenously at home. The patient had previously consumed this extract orally for constipation and decided to inject it to achieve a stronger laxative effect. Immediately after injection, he developed symptoms with chest pain, palpitations, dizziness, nausea, vomiting, and diarrhea. He presented to the ER the following day for increasingly severe chills and weakness. On arrival, he was in shock with a serum lactate of 6.5 mmmol/L and acute kidney injury with a creatinine of 3.35 mg/dl. He was subsequently admitted to the medical intensive care unit, where he received supportive care. He had several notable electrolyte abnormalities, and blood cultures grew opportunistic gram-negative organisms—Cronobacter sakazakii and Roseomonas gilardii—isolated at different time points. Discussion This case illustrates a severe adverse reaction following intravenous administration Annona muricata herbal preparation. Although soursop is commonly marketed for its antioxidant benefits, its bioactive compounds can inhibit mitochondrial function, leading to lactic acidosis and organ dysfunction. The rapid onset of symptoms and development symptoms and laboratory abnormalities suggest a direct systemic toxicity. This case underscores the dangers of unregulated remedies and potential harm that may arise when such products are administered in non-approved routes. In addition, the variety of non-sterile organic material may give rise to separate blood stream infections over different time frames, necessitating re-examination of blood sterility. This abstract is funded by: N/A
Makhoul et al. (Fri,) studied this question.