RUTA GRAVEOLENS AS AN ETHNIC ABORTIFACIENT

Objective: For centuries, herbal remedies have been used as abortifacients. The use of specific agents tends to follow cultural lines. An abortifacient tea made from the leaves of common rue (Ruta graveolens) is a well-established remedy in Mexican culture. We report a case of toxicity in a healthy woman after consumption of such a tea. Case Report: A 26-year-old female of Mexican descent presented to the hospital complaining of abdominal pain and a sensation of ants crawling over her body. The previous day the patient had been informed that she was pregnant and received counseling regarding an elective termination of pregnancy. A relative cautioned her that the surgical procedure involved would be very painful and advised her to make a tea from chocolate, cinnamon and the leaves of a plant growing in her garden. After consuming the beverage, the patient developed abdominal cramps and yellow vaginal discharge. She drank a second dose 5 hours later, vomited several times and developed formication. At this point she sought medical attention. Her physical examination was unremarkable and all standard laboratory tests were within normal limits, except for large ketonuria and a positive urine pregnancy test. A family member was sent home to retrieve the plant used, which was identified as common rue (Ruta graveolens). The treating physicians were also concerned about quinine and sent serum for a quinine assay, which was negative. After two days, her symptoms resolved without any complications. The patient was discharged and sent for pregnancy counseling. Conclusion: The most common adverse affect of rue is a furanocoumarin-induced photodermatitis. Psoralens present in the plant can act as a vesicant and may induce vomiting. However, animal studies have suggested that certain chemicals present in the plant (chalepensin and quinoline) can prevent implantation or increase muscle activity (i.e. abdominal cramps). Either of these mechanisms can induce an abortion. The list of herbal abortifacients and emmenagogues is too extensive for clinicians to remember. Awareness of specific ethnic remedies can assist in the management of patients poisoned by such remedies.
Sharma AN, Nelson LS, Hoffman RS. New York City Poison Control Center, New York, New York, [...]