Neem Oil Poisoning as a Cause of Toxic Encephalopathy in an Infant

Excerpt

To the Editor: Neem oil (Margosa oil) is deep yellow extract of neem tree (Azadirachta indica A. Juss) seeds widely used in India as a traditional medicine for various skin diseases, as pesticide/insecticide, and in cosmetics [1, 2]. Toxic ingredients include azadirachta, nimbin, nimbinin, nimbidin, nimbidol, picrin, and sialin [1, 2]. Poisoning is usually accidental by nasal or oral administered to infants and children for cough and cold, pain abdomen, and deworming; or rarely suicidal [2]. Even small doses can cause toxicity include vomiting, drowsiness, generalized seizures, coma, and severe metabolic acidosis especially in infants and young children [3]. Management is usually supportive in form of control of airway, breathing and circulation; avoid gastric lavage; control of convulsions; and correction of metabolic acidosis with intravenous fluids, oxygen, and sodium bicarbonate [1, 2]. …