Nausea and vasoconstriction, the two known problems
Updated
Nausea and the effects of narrowed blood vessels are the two problems that come back in almost every study and case report on Hawaiian baby woodrose seeds. Both follow from the chemistry: the seeds contain ergot alkaloids, and ergot alkaloids act on the gut and on the muscle in blood vessel walls.
Nausea and vomiting
In every case series we found, stomach complaints top the list:
| Data set | Nausea or vomiting |
|---|---|
| Swedish Poisons Information Centre, 2000 to 2010 (65 cases) | 29 cases, the most common symptom |
| Texas poison centres, 2000 to 2018 (29 cases) | nausea 34.5%, vomiting 24.1% |
| Polish user reports (7 cases) | nausea in 4, within 30 minutes |
| Dutch Poisons Information Centre, about 2014 to 2018 | nausea and vomiting among the main symptoms |
Sources: RIVM, 2020; Forrester, 2019; Juszczak and Swiergiel, 2013.
The nausea usually starts early, from 10 minutes to 2 hours after swallowing, and in volunteer studies it was often strong enough to end the session. In the 1968 experiments with pure LSA, nausea and vomiting came with sweating, dizziness and a general feeling of being ill. Higher doses were not tested because of the expected adverse effects (Heim et al., 1968, in RIVM, 2020).
The cause is not fully understood. LSA acts on serotonin and dopamine receptors, and both systems are involved in nausea (Paulke et al., 2013). Other alkaloids in the mixture may add to it.
Two practical risks follow from vomiting. Someone who is confused or drowsy can choke on vomit, so a person who is vomiting and not fully alert should be laid on their side. And repeated vomiting over hours leads to fluid loss.
The Dutch assessment noted that users often smoke cannabis to suppress the nausea. Cannabis was involved in several of the serious cases on this page, including the fatal one.
Narrowed blood vessels and blood pressure
Ergot alkaloids are known for making blood vessels contract. Historically, poisoning by ergot-infected rye (ergotism) caused cold, painful limbs and gangrene for exactly that reason. The alkaloids in Hawaiian baby woodrose seeds are related compounds, and the same mechanism shows up in the data:
- In the lab, LSA made blood vessels from cattle contract and acted on the adrenaline (alpha-adrenergic) and serotonin 5-HT2 receptors that control vessel tone (Oliver et al., 1993).
- In healthy volunteers, all four participants of the 2012 study had a temporary rise in blood pressure after the same dose per kilogram; two had what the authors called cardiovascular dysregulation (Kremer et al., 2012).
- In poison centre data, a fast heart rate was recorded in 24.1% of Texas cases and in 12 of the 65 Swedish ones.
Case reports give an idea of the size of the effect:
| Case | Heart rate | Blood pressure | Other |
|---|---|---|---|
| 18-year-old, 12 seeds | 110 | 170/90 | dilated pupils, vomiting (Al-Assmar, 1999) |
| 18-year-old, 15 seeds plus other drugs | 119 to 144 | up to 179/114 | acute psychosis (Gertsch and Wood, 2003) |
| 23-year-old, about 30 seeds | 154 | 152/96 | cold hands and feet, muscle breakdown, acute kidney injury, recovered (Meyer Karre and Heinrich, 2014) |
| 39-year-old, LSA of unknown amount, on an antidepressant | 120 | 185/130 | seizures and a brain swelling syndrome (PRES), recovered (Legriel et al., 2008) |
In the volunteer study the rise in healthy adults was temporary. For someone with heart disease, high blood pressure, vascular disease or a history of stroke, it is a real danger. The same holds for anyone taking another substance that narrows blood vessels or raises blood pressure. The who should stay away page lists these groups.
Mental crises and accidents
The physical problems are the most common, but the most serious outcomes in the literature were psychological and behavioural:
- A 17-year-old who took eight seeds with alcohol arrived at hospital frightened, disoriented, with memory gaps, delusions and hallucinations. Symptoms faded within 24 hours (Göpel et al., 2003, in RIVM, 2020).
- In Denmark, two young men took soaked seeds and then smoked cannabis. About three hours later one of them became severely agitated and jumped from a window. He died; his friend survived (Klinke et al., 2010).
- In the 2012 volunteer study, one of four healthy, drug-naive participants developed a psychosis-like state at a body-weight-adjusted dose of about four seeds (Kremer et al., 2012).
These cases share features that come back in other reports: young users, other substances on top, and no sober person who could intervene.
What is not known
Almost nothing is known about longer-term effects. There are no studies of repeated use, of effects on the unborn child, or of genotoxicity or cancer risk (RIVM, 2020). Product labels do not change that: capsules sold as herbal products may contain undeclared ingredients, which the Dutch assessment flags as an additional uncertainty.
In an emergency
Call the emergency number (112 in Europe, 911 in North America, 999 in the UK) if someone has chest pain, a severe headache, a seizure, trouble breathing, cold or discoloured fingers or toes, loses consciousness, or is a danger to themselves or others. Tell the ambulance crew what was taken and when. Poison information centres give advice to doctors and, in many countries, to the public.