Acute toxicities of betel nut: Rare but probably overlooked events

Background: Betel nut chewing has long been a social habit it? Taiwan and o ther Asian and tropical countries. It produces various autonomic and psycho neurologic effects including tachycardia, flushing, warmth, cholinergic act ivation, alertness, and euphoria. Although the oral carcinogenic effects ar e well known, data concerning its acute toxicity are few. To better underst and the toxicity of betel nut, cases reported to the Taiwan Poison Control Center as probable or possible betel nut-related toxicity (January 1988-Jun e 1998) were reviewed. In the 17 cases suitable for review (14 males, 3 fem ales, age 21 to 60 years), the most common manifestations were tachycardia/ palpitations (7); tachypnea/dyspnea (6); hypotension and sweating (5); vomi ting, dizziness, and chest discomfort (4); abdominal colic, nausea, numbnes s, and coma (3); and acute myocardial infarction and related manifestations (2). The reported quantity, of betel nut used was low (I to 6 nuts), excep t an extract of 100 betel nuts was used in 1 case and 66 chewed in another. Most cases recovered within 24 hours after the exposure. One patient devel oped probable acute myocardial infarction and ventricular fibrillation and died despite repeated cardiac defibrillation. Although betel nut chewing is widespread, significant toxicity as reported to a poison center is rare. B ecause most betel nut-related effects are transient and mild in nature, the incidence of such events is likely to be underreported. Nevertheless, bete l nut chewing can produce significant cholinergic, neurological, cardiovasc ular, and gastrointestinal manifestations. It is possible that it may aggra vate cardiac diseases in susceptible patients but this hypothesis must be f urther investigated. Treatment is symptomatic. With timely support, rapid a nd complete recovery. is anticipated but a small risk of major complication s cannot yet be discounted.