BONGKREK POISONING

PEDIATRIC EMERGENCY DEPARTEMENT

MEDICAL FACULTY OF NORTH SUMATERA
H. ADAM MALIK HOSPITAL
 INTRODUCTION

   BONGKREK – TEMPE BONGKREK

-   FOOD STUFF OF COCONUT BUNGKIL
EXTORTED OF COCONUT MILK
-   MAIN FOOD SOURCES IN CENTRAL JAVA

   ONCOM
- PEANUT DREGS  FROM PEANUT OIL
- TEMPE OF SOYBEAN
 FERMENTATION PROCESS USE BEAN/YEAST
OF RHIZOPUS OLIGOSPORUS
 BONGKREK :
- COASTAL COCONUT DREGS POISONED  
MANY VICTIM
- BONGKREK ACID CONTAMINATED
CLOST. BOTULINUM ANAEROB  SPORA
 BACTERIUM COCOVENANS :
GLISERIUM  TOKSOFLAVIN
 ONCOM :
ASP. FLAVUS & PEN. AFLATOKSIN
 TEMPE OF SOYBEAN :
- POISONED (-)
- EXCEPT CONTAMINATED BY BACTERIUM
WILL BE DONE
CASE
- IN CENTRAL JAVA  ITS HAPPENED SINCE 1902
- VAN VEEN & MARTEN MD (1933 - 1934) :
MAIN COUSED  PSEU. COCOVENANS

SYMPTOMS
1. 12-48 HR: MALAISE, ABD CRAMP, VOMITING,
DIARRHEA.
2. SEVERE : HEADACHE, SWEATING, SEIZURE.
3. UNCOUNSIOUS NESS & COMA
4. DEATH  IF CAN’T HELP (HOURS – DAY)
MANAGEMENT

 BRING TO HOSPITAL IMMEDIATELY

 GASTRIC LAVAGE OR VOMITING
 IVFD DEXTROSE, NS, PLASMA
 ANTI TOKSIN

PREVENTION

1. LIGHTING
2. AVOIDING CONTAMINATION
3. COCONUT BUNGKIL  STILL FRESH
4. BETTER BE PUT TO THE SUN
PROCESS OF POISON

FERMENTATION PROCESS  HOT UNTIL 400C 

PSEU. COCOVENANS  ENZYME HYDROLIZED 
GLISEROL & FATTY ACID (OLEIC ACID) 
BONGKREK ACID & TOKSOFLAVIN

TOXICOLOGY

BONGKREK ACID :
- STRONG POISON  DANGEROUS OF HEALTH
- BLOCK OF MITOCHONDRIA ENZYME, DISTURB
MECHANISM OF FOSFORILASE OXIDATIVE,
CARBO HYDRATE & FAT
- BLOCK ATP  DISTURB GLYCOGEN MET 
GLUCOSE   DEATH (4 HOURS)
 CHARACTERIZED POISON OF BONGKREK ACID
& TOKSOFLAVIN  TERMOSTABIL.

ONCOM :
HEPATOTOXIN POISON  DAMAGED THE LIVER

 DIFFERENTIARED:
C7 H7 N5 O2 = TOKSOFLAVIN  151 DALTON
C28 H38 O7 = BONGKREK ACID  486 DALTON
 CASAVA POISONING

MUNAR LUBIS

PEDIATRIC EMERGENCY DEPARTEMENT

MEDICAL FACULTY OF NORTH SUMATERA
H. ADAM MALIK HOSPITAL
INTRODUCTION

-   CASAVA = MANIHOT UTILISIMA  GROWS IN

INDONESIA
-   AT SOME AREA  MAIN DIET
-   FLOUR MATERIALS OF TAPIOKA, BISCUITS ETC
-   SWEET, BITTER  STARCH IN TEXTILE
FACTORY
-   CONTAIN AMYDALIN, CYANIDE ACID CAN BE
STRUCK FROM ITS TYING.
TOXICOLOGY

-  DEPEND OF TYPE
-   STRONG POISON  ASPHY XIA
-   ETIO: CONSENTRATE & PROCESSING
-   WATER SOLUBLE
-   DISTURB OXYDATION (SITOCHROM OXYDASE)
 O2 CAN’T BE UTILIZED, EX: BRAIN
-   LEVEL OF STIMULATION CNS:
   SEIZURE  HYPOXIA
   DEATH  RESPIRATORYFAILURE
   IRREGULAR OF HEART.
-    ABSORBED BY SKIN & MUCOSA
CYANIDE SALT  DANGEROUS
 LETAL DOSE : 60 –90 mg
-  DETOXIFICATION + ENZYME RODANASE  ION
OF TIOSIANAT (CYANIDE ACID)
-  ENZYME (EX : LIVER)  THE BODY CAN
DETOXIFICATION
- ENZYME WORK VERY SLOWLY  QUICKLY IF
INCLUDE SULFUR
BASED OF Na. TIOSULFAT INJECTION

SYMPTOMS

1. NAUSEA, VOMITING, DIARRHEA, CONFUSE.

2. TACHYCARDIA
3. MALAISE, UNCOUNSIOUSNESS, APATHIC, COMA
4. SHOCK: - DEATH
- RECOVER  IF 4 HOURS STILL LIFE
DIAGNOSIS

EASY  ANAMNESIS TO THE PARENTS FOR

SYMPTOMS AFTER EATING
 
MANAGEMENT

1. < 4 HOURS  REACTION FOR VOMITING

2. Na. TIOSULFAT 30 %
3. O2  CYANOSIS

PROGNOSIS

CHILD WILL RECOVER  TREAT. IS QUICKLY GIVEN

PREVENTION

1. SELECT CASAVA ABLE TO BE EATEN

BITTER  CYANIDE ACID 
2. CASAVA FOR THE MATERIALS MAKER OF
STARCH/ BEGUNG CAN’T EATEN  POISONING
3. CASAVA BEFORE COOKED  TO BE PARED,
CUT SMALL, SPLIT & CLEANED IN THE WATER
4. AFTER WASHED OUT  SOAK IN THE WARM
WATER FOR SEVERAL HOURS