Senna pods deaths

The shocking news that two young children had died after being dosed with senna pods’ tea, followed by some sort of herbal tea and then an anti-diarrhoeal has revealed the continuing laxity with which drugs are administered, the lack of standards governing their importation and sale as well as the lack of technical ability to seriously investigate such a case. While senna pods are a herbal laxative, guidance as to their use should still be provided.

Research reveals that senna pods are widely used as a children’s laxative. They are also used for cleansing and detoxifying the body and adults also use them as a laxative. Because they have been in use for years, it has been assumed that they are harmless. However there are drug interactions, contraindications and side effects associated with senna, and in other countries measured dosages are recommended depending on what the herb is to be used for. According to information available online, if used over a prolonged period, the herb disturbs the water and electrolyte balance of the body. An increased loss of water and salts, especially potassium salts, may occur and ultimately a dangerous electrolyte imbalance can develop that can be fatal if it persists. It is also said that large doses of senna pod tea may cause gastric disturbance, nausea and diarrhoea.

In Guyana, senna pods and leaves are sold in community shops, pharmacies and groceries and have been for decades, with absolutely no standards governing their sale; no guidance as to usage and dosage is ever offered. While some shops, particularly pharmacies would have the senna pods and leaves pre-packed for sale in sealed plastic bags, it is not unusual to see shop attendants using their naked hands to pick up an odd amount of senna leaves or pods, wrap them in unused newsprint and hand the package over to a customer. The customer then takes the parcel home, soaks the senna pods in water and drinks the liquid without even considering that the herb would have been handled by unwashed hands, not to mention that its storage prior to purchase might have been compromised.

In the case of the late Afiena and Aaliyah Ramdeen, the senna pods that were used were purchased from a community shop; this newspaper was unable to ascertain the conditions under which they were sold. After they developed diarrhoea, the girls, aged five and three respectively, were given the anti-diarrhoea medication Lomotil, a brand name for the drug combination diphenoxylate hydrochloride  and   atropine sulfate. The Internet drug index RX List says Lomotil is not recommended in children under two years of age and should be used with special caution in young children as the nutritional status and degree of dehydration must be considered. The liquid formula is what is given to children under 13 years old. Afiena and Aaliyah, who would have been dehydrated from the diarrhoea were given adult doses of Lomotil in ignorance.

This newspaper had also been told by Troy Ramdeen, the father of the dead girls, that after their health did not improve having been given the Lomotil, he had given them some “bush tea,” which they regurgitated. He did not tell our reporter what herb/s would have been used to make that tea and one wonders if in the course of their investigation, the police took cognizance of that. One wonders too, whether anyone in the local medical profession would be moved to investigate, purely to advance science, how senna and Lomotil react when combined and the effects the “bush tea” may have had on this fatal combination since it has already been documented that the girls died of an overdose of medication.

Meanwhile, it will be interesting to see how long it will take for the knee-jerk reaction to kick in, since in this case, it is very much needed. Teams should be visiting shops offering senna pods and leaves (as well as all other herbal preparations) for sale to check on storage, shelf-life and packaging. Standards must be drawn up to cover these areas and must be enforced. The government health authorities should be examining why Lomotil is available over the counter and whether this should be changed.

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