International School of Asia and the Pacific - Kalinga

Pharmacy Department
Pharmaceutical Toxicology

Activity 5
Food Poisoning
Name: Mendoza, Jhunlaine Kate G.

Gayaman, Maxine

Bula-at, Marjorie

I. Discussion:

Food poisoning is caused by ingesting food or drink that has been contaminated with either:
(1) chemicals such as insecticides or food toxins including fungi (e.g. poisonous mushrooms), or
(2) gastrointestinal infections of bacteria, viruses, or parasites. Understanding the cause
should be the first priority, verifying the diagnosis of such poisoning.

Food-related poisoning are more prevalent in the warmer months and during the holidays that
at other times. There are several forms of food poisoning. Bacterial food poisoning is often
caused by bacteria in food that has been poorly prepared. Salmonella is one of the most
common culprits and is found in many farm products such as eggs and chickens. Toxic food
poisoning such as botulism can be due to poisons caused by bacteria in certain types of foods,
including honey and fish. Some foods are entirely poisonous or have components that are
poisonous if not properly prepared (crab and some fish are among the most common culprits).

Recognition of some factors that caused food contamination should be next step. This
included the knowledge of where the food was grown, and its environment. Handling, storing
and preparing foods are the most important areas to tackle in order to reduce the possibility of
food contamination.

In developing countries, food-borne or water-borne diarrhea, is noted by the WHO as

responsible for about 1.8 million deaths each year. In the Philippines, diarrhea ranked second
among the 10 leading causes of morbidity in 2002. A very large portion of diarrhea among
Filipinos is thought to be food- or waterborne, and bacterial, viral, or protozoal in origin. For
example, there were 47 deaths out of 4,403 gastroenteritis cases in 2004 and one suspected
E. coli 0157H7 woman-victim in 2005. Other food poisoning reports suggested cassava and
mushrooms as culprits because of contamination with chemical toxins or known poisonous
varieties. In 2005, there were 25 children who died after eating cassava contaminated with
pesticides. (Food and Nutrition Research Institute, DOST, 2008)

At the farm level, some vegetables were found positive for regulated pesticides. At the
slaughterhouses and poultry dressing plants, microbial pathogens were recorded. Antibiotic
residues were also detected in animal carcasses. Heavy metals, particularly lead and cadmium,
as well as histamine in fish, while detectable, were below the tolerable or Codex limits, for now.
Red tide monitoring revealed continuous, although infrequent, exposure risks. Aflatoxin
monitoring of agricultural crops and processed products showed reduced but still persistent
over-the-limit incidence in local corn, peanuts, copra meal, and mixed feeds. ( Food and
Nutrition Research
Institute, DOST, 2008)
At the processor level, violations were registered on the: (1) misuse of food additives like
sodium nitrite and nitrate in meat/meat products, caffeine in cola drinks, sulphur dioxide
in dried fruits; (2) use of non-permissible food additives like borax in noodles, snack foods and
sago, potassium bromate in flour, sodium cyclamate in juice drinks and ready-to-mix
powder drinks; (3) use of non-permissible food colors such as Rhodamine B in candies and
biscuits; (4) presence of food contaminants such as aflatoxins in peanut butter, corn-based
snacks; 3-MCPD in soy sauce; histamine in marine product; (5) existence of heavy metals
in herbal food supplements; (6) presence of allergens in hotcake mix, cyanide in milk
powder, filth in bottled alcoholic and non-alcoholic beverages; (7) defective canned products;
expired food products; and (8) presence of microorganisms like Salmonella in noodles,

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Staphylococcus aureus in hotdog and noodles, Escherichia coli in assorted products, coliforms
in taho, molds, and yeasts in cakes.

When faced with suspected food poisoning, ask what food has been eaten in the last 48 hours.
Food poisoning can take some time to show (however, toxic food poisoning tends to act much
more quickly). Be alert to the possibility of food poisoning if there is any combination of the
following: strange-tasting food or food that has been left out in the heat; several people with
the same symptoms, and undercooked or reheated food.

Mechanism of Action: Enterotoxemia causes altered gastrointestinal biochemical

pathways and activation of autocoids (prostaglandins, kinins, etc.) that leads to altered motility,
permeability, and CNS interactions.

One of the dangers of food poisoning is loss of body fluids. The dehydration that results
from this fluid loss can be serious if the fluids are not replaced quickly enough. Dehydration is
especially serious in the very young and the very old, and, in some cases, treatment may be
required in hospital. Severe dehydration involves such manifestation: dry mouth, decreased
urination, dizziness, fatigue, or increased heart rate or breathing rate. Drink clear fluids, starting
with small sips and gradually drinking more. If vomiting and diarrhea last more than 24 hours,
drink an oral rehydration solution.

Treatment: Food intoxications can mimic serious problems such as gastric or intestinal
torsions and foreign bodies. A thorough work-up including radiographs is warranted to ensure
proper diagnosis and treatment. In cases where vomiting has occurred, the patient may have
purged himself, thus requiring only supportive care (fluids, activated charcoal with a
cathartic). If vomiting has failed to purge the stomach, treatment is by gastric lavage,
repeated doses of activated charcoal, and perhaps use of a cathartic. Antiemetics may
be necessary if vomiting continues after decontamination of the GI tract. Kaopectate can be
used as an absorbent or gastrointestinal protectant. Broad-spectrum antibiotics are given at the
doctor’s discretion. Enterotoxemia cases may appear to go well only to relapse. If relapse
occurs, it usually does so within 48 hours. This may be related to onset of gut stasis and
endotoxemia.

II. Materials

Sample labels of food items/snack product

Recent news on food poisoning (preferably newspaper source)

III. Procedures:

Group Work

A. 1. Bring 3 sample labels (immediate container) of the following food items/snack:

a. Canned goods (processed meat)
b. Noodles
c. Corn-based snacks
d. Herbal food supplements
e. Ready-to-mix powder drinks

2. From the listed ingredients found in each label, identify one which will potentially
develop risk to human health.
3. Provide literature search on the identified substance and check for any toxicological
information

B. 1. Collect at least 2 examples of recent news on food poisoning cases in the country
2. After identifying the food or substance involved in the case, describe its physical and
chemical characteristics, the signs and symptoms of poisoning, the possible methods of
decontamination or treatment (antidotes) plan done for the victims.
3. Provide your reaction on the news that you had read. What do you think will be the
pharmacist intervention?

C. Present your outputs to the class

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IV. Results/Observation/Conclusion

A. Analysis of Sample Food/Snack Item Labels:

List of Ingredients: Canned Goods
Sample Label 1 Sample Label 2 Sample Label 4
Product Name: Lucky 7 Carne Product Name: Spam Product Name: Purefoods
Norte Corned Beef

Toxicological Information of the Identified Substance

Substance: Substance: Substance:
Saturated fat and sodium- high Sodium- Spam contains large Saturated fat and sodium- high
levels of saturated fat and amounts of sodium. A diet levels of saturated fat and
sodium that may increase your containing excessive amounts sodium that may increase your
risk of heart disease and of sodium can increase the risk risk of heart disease and
stroke. for high blood pressure and stroke.
cardiovascular diseases.

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 List of Ingredients: Noodles
Sample Label 1 Sample Label 2 Sample Label 4
Product Name: Maggi instant Product Name: Nissin ramen Product Name: Pancit canton
noodles

Toxicological Information of the Identified Substance

Substance: Substance: Substance:

 MSG- which MSG  Sodium- Consuming  Ethylene oxide

toxicity are too much sodium can Exposure to ethylene oxide may
hypertension, obesity, negatively impact your cause:
gastrointestinal tract health and has been Headache.
troubles, and linked to an increased Nausea.
impairment of function risk of heart disease, Vomiting.
of brain, nervous stomach cancer and Diarrhea.
system, reproductive, stroke. Difficulty in breathing.
and endocrine system. Drowsiness.
Weakness.

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 List of Ingredients: Corn-based Snacks
Sample Label 1 Sample Label 2 Sample Label 4
Product Name: Sweet corn Product Name: Boy bawang Product Name: Super crunch
cornick cornchip

Toxicological Information of the Identified Substance

Substance: Substance: Substance:
 MSG- which MSG  MSG- which MSG
toxicity are toxicity are  MSG- which MSG toxicity
hypertension, obesity, hypertension, are hypertension, obesity,
gastrointestinal tract obesity, gastrointestinal tract
troubles, and gastrointestinal tract troubles, and impairment
impairment of function troubles, and of function of brain,
of brain, nervous impairment of nervous system,
system, reproductive, function of brain, reproductive, and
and endocrine system nervous system, endocrine system
reproductive, and
endocrine system

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 List of Ingredients: Herbal Food Supplements
Sample Label 1 Sample Label 2 Sample Label 4
Product Name: St. Johns Wort Product Name: Naturelo Iron Product Name: Naturelo
Capsule with Vitamin C Vitamin E

Toxicological Information of the Identified Substance

Substance: Substance: Substance:
St. John’s wort- can accelerate Vitamin C- can cause diarrhea Vitamin E- can increase the
the breakdown of many drugs, when taken in doses higher action of blood thinners,
including antidepressants and than the gut can absorb (but leading to easy bruising and
birth control pills, thereby some patients can tolerate nosebleeds.
reducing their effectiveness. 5,000mg to 25,000mg per
day).

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 List of Ingredients: Ready-to-Mix Powder Drinks
Sample Label 1 Sample Label 2 Sample Label 4
Product Name: Kool-Aid Product Name: Tang Orange Product Name: Milo

Toxicological Information of the Identified Substance

Substance: Substance: Substance:
Aspartame- Artificial Tartrazine - this causes High sugar content- it tends to
sweeteners such as aspartame sometimes-severe increase the triglycerides and
provide sweetness without hypersensitivity reactions and fat levels in your blood, and
providing the body with might trigger hyperactivity and higher triglycerides increase
energy, and this effect on the other behavioral effects in your risk of heart disease
body may stimulate appetite. children. Used numerous
bakery goods, beverages,
dessert powders, and many
other foods as well as
pharmaceuticals and
cosmetics.

B. Case Analysis

 Lishou Slimming Coffee contains hidden drug ingredients. The Food and Drug
Administration (FDA) is advising consumers not to purchase or use Lishou Slimming
Coffee, a product promoted and sold for weight loss on various websites and possibly in
some retail stores. FDA laboratory analysis confirmed that Lishou Slimming Coffee
purchased from [Link] contains sibutramine and desmethylsibutramine.

Identified Poison:

 Sibutramine and Desmethylsibutramine

Physico-chemical Properties:

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 LiShou is a 100% natural slimming pill that helps you burn off more fat with a lotus
formula, cassia seed, Tuckahoe, and bitter orange, and synephrine.

 Tuckahoe
Also referred to as Poria cocos extract, this saprophytic fungus is famous in Asia, according
to Progress in Molecular Biology and Translational Science. Its primary uses include as an
anti-inflammatory and immunomodulatory agent

 Bitter Orange
Is a type of tree that is native to Asia. Synephrine is the active ingredient, and it functions
similar to ephedra, providing a stimulating effect on the body. It affects the nervous system,
causing an increase in heartbeat and blood pressure.

 Lotus
May have some nutritional health benefits and that this ingredient may be able to have
anti-obesity properties.

Mechanism of Toxicity:

Sibutramine is a controlled substance that was removed from the market in October 2010
for safety reasons. Desmethylsibutramine is a substance structurally similar to sibutramine.
This product poses a threat to consumers because sibutramine is known to substantially
increase blood pressure and/or heart rate in some people and may present a significant risk
for people with a history of coronary artery disease, congestive heart failure, arrhythmias, or
stroke. This product may also interact, in life-threatening ways, with other medications a
consumer may be taking.

Clinical Signs and Symptoms of Toxicity:

LiShou comes with quite a few potential side effects. This is primarily due to the illegal use
of sibutramine in the product.
 This incredibly dangerous substance can cause heart palpitations. People with a history
of heart conditions must consult their doctors before using LiShou coffee and LiShou
capsules.

 Also, the FDA has warned that sibutramine might aggravate heart problems. Some other
side effects include:
o Headaches
o Nausea
o Jitters
o constipation.

Management/Treatment Procedures/Antidote:

 A qualified physician best prescribes the use of any drug or supplement. However, the
generally accepted method of using LiShou capsules is to take one capsule in the
morning, either before or after eating breakfast. If you are obese, they suggest adding
one more capsule in the evening. You should take a maximum of two capsules daily.
While using LiShou capsules, you must drink 3-5 liters of water every 24 hours.

Remarks/Conclusion:

LiShou is a 100% natural slimming pill that claims to help users burn off more fat with a
formula consisting of lotus, cassia seed, Tuckahoe, bitter orange, and synephrine. This product
is marketed towards women and produced by Yunnan bai’an Medicine Science and Technology
Co. Ltd.

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 There is no solid scientific evidence to support the effectiveness of LiShou as a weight
loss supplement. However, research has been conducted into the individual ingredients, and
Bitter Orange is believed to be the stimulant that drives LiShou’s effects.

Before taking any drugs and supplements, you have to consult your doctor or know your
condition first, maybe you have heart problem or any health condition, and when taking any
slimming pills you will increase your fluids intake as this pills urges your body to work hard
inside to burn fats, and when you feel anything unnecessary stop it. the effects may vary each
individual. But the most important is know yourself because nobody will help you even the
company when something worst will happen to you in the future, that is your choice.

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Name: ___Mendoza, Jhunlaine Kate G._______

V. Questions to Answer:
1. What is the evidence that MSG causes brain damage?

MSG is monosodium glutamate, which the US Food and Drug Administration

explains is “the sodium salt of the common amino acid glutamic acid. Glutamic acid is
naturally present in our bodies, and in many foods and food additives”.

And there is an article making the statement untrue and it states that “The claim
MSG kills brain cells and damages the nervous system is false. Concerns about a link
between MSG and some physical symptoms have been traced to a letter to a medical
journal in 1968, which itself has been disputed.

Food safety authorities, scientific studies and experts say MSG is safe to
consume. Though,The Food Standards Australia New Zealand (FSANZ) website says: “A
small number of people may experience a mild hypersensitivity-type reaction to large
amounts of MSG when eaten in a single meal. Reactions vary from person to person but
may include headaches, numbness/tingling, flushing, muscle tightness, and general
weakness. These reactions normally pass quickly and do not produce any long-lasting
effects.”

2. How will you explain the mechanism of toxicity of borate and nitrate ions?

 MECHANISM OF TOXICITY OF BORATE

A. The mechanism of borate poisoning is unknown. Boric acid is not highly corrosive but is
irritating to mucous membranes. It probably acts as a general cellular poison. The organ
systems most commonly affected are the skin, GI tract, brain, liver, and kidneys.

B. Pharmacokinetics. The volume of distribution (Vd) is 0.17–0.50 L/kg. Elimination is

mainly through the kidneys, and 85–100% of a dose may be found in the urine over 5–7
days. The elimination half-life is 12–27 hours.

 MECHANISM OF TOXICITY OF NITRATE

Plants absorb nitrate which is normally converted to nitrite by the nitrate
reductase system and incorporated into amino acids and proteins. Genetic or
environmental factors that interfere with or inhibit the function of the nitrate reductase
system allow for nitrate to accumulate in the plant. For example, in response to
stressful conditions, sorghum species have reduced reductase activity. Drought and
conditions of reduced sunlight will also decrease the activity of the nitrate reductase
system.

Despite the decreased activity, nitrate is continuously absorbed by the plant and
accumulates to abnormally high levels. Ruminants consuming these plants convert the
nitrate to nitrite and then to ammonia. Nitrate toxicity is a function of the amount and
rate at which nitrate is consumed. When the animal consumes a normal forage diet
containing large amounts of nitrate, the conversion of nitrite to ammonia becomes the
limiting factor allowing nitrite to accumulate to toxic levels. Toxicity occurs following the
absorption of nitrite into the blood which oxidizes iron in hemoglobin from the ferrous
(+2) to ferric (+3) state. The resultant methemoglobin has a very poor affinity for
oxygen which greatly reduces the oxygen-carrying capacity of red blood cells. Death
from anoxia may occur if 70-80% of the hemoglobin is converted to methemoglobin.

3. What is the antidote for nitrate poisoning and how will you prepare it?

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  Treatment and Prevention
Methylene blue is a specific treatment for nitrate toxicity. It causes a rapid conversion of
methemoglobin to hemoglobin. The dose of methylene blue is reported as 4-30 mg/kg IV of
a 1% solution to be given as soon as clinical signs are identified. However, methylene blue
is not approved for use in food animals. In addition, the stress associated with collecting,
restraining and treating animals with severe methemaglobinemia must be considered.
Identification and removal of the source of nitrate is indicated as well. The 9th edition of
Veterinary Medicine by Radostits et al reports that less than 0.6% of nitrate in the total diet
is recommended. They also recommend that cows not be grazed on feed that contains
more than 1% nitrate and slightly less when the cattle are not grazing the feed. Identifying
the nitrate source and reducing the exposure is the key to controlling nitrate toxicity. When
it occurs, however, rapid diagnosis and prompt treatment are necessary to prevent severe
mortality loss.

4. How will you describe the clinical manifestations of food borne infection and
intoxication?

 Campylobacter jejuni – Foodborne Infection

 Found
Widely distributed in nature; can be isolated from meats, milk, vegetables, and fish.

 Transmission
Bacteria produce a toxin that causes illness. Vomiting-type outbreaks have usually been
associated with rice products and other starchy foods such as potatoes, pasta, and cheese
products. Sauces, puddings, soups, casseroles, pastries, and salads have also been
implicated in outbreaks.

 Symptoms
Food poisoning is characterized by nausea and vomiting 0.5 to six hours after the ingestion
of a contaminated food product. In more severe cases, abdominal cramps and diarrhea
might occur with symptoms lasting up to 24 hours.

 Clostridium botulinum – Foodborne Intoxication

 Found
Widely distributed in nature; soil and water on plants and intestinal tracts of animals and
fish. Grows only in little or no oxygen.

 Transmission
Bacteria produce a toxin that causes illness. Improperly canned foods, garlic in oil,
vacuum-packed and tightly wrapped food.

 Symptoms
Toxins affect the nervous system. Symptoms usually appear in 18 to 36 hours, but can
sometimes appear as few as four hours or as many as eight days after eating. Double
vision, droopy eyelids, trouble speaking and swallowing, and difficulty breathing may
occur. Can be fatal in three to 10 days if not treated.

5. What are the genetically modified (GM) foods? Provide 3 examples of toxicity studies done
to GM crops.

Genetically modified organisms (GMOs) can be defined as organisms such as plants,

animals or microorganisms in which the genetic material (DNA) has been altered in a way that
does not occur naturally by mating and/or natural recombination. The technology is often called
“modern biotechnology” or “gene technology”, sometimes also “recombinant DNA technology”
or “genetic engineering”. Foods produced from or using GM organisms are often referred to as
GM foods.

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Common genetically altered foods or crops are:

a. Cotton
b. Tomatoes
c. Papaya
d. Rice
e. Potatoes
f. Corn
g. Soy
h. Milk
i. Canola Oil
j. Aspartame

 The safety assessment of GM foods generally focuses on:

(a) direct health effects (toxicity)
(b) potential to provoke allergic reaction (allergenicity)
(c) specific components thought to have nutritional or toxic properties
(d) the stability of the inserted gene
(e) nutritional effects associated with genetic modification
(f) any unintended effects which could result from the gene insertion.

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