*13.3.2. Human toxicity*

Studies have shown that the ingestion of *C. occidentalis* can cause severe purging possibly due to the anthracene glycoside content [59]. Whereas this may produce great discomfort and pain in adults, in a child, this can be fatal; thus, while few pods might not have any ill effect in an adult or an older child when eaten, it could cause death in a young child [60]. Other *Cassia* species products such as senna extract (*C. acutifolia*) consumed as health drink resulted in severe hepatotoxicity in an adult [61]. *C. senna* leaves and pods have been used in orthodox medicine and still form part of traditional pharmacopeia [53].

The clinical spectrum of *C. occidentalis* poisoning in children resembles the toxicity observed in animals. Most cases in children occur when they eat the beans. As with animals, the clinical toxic features depend upon the amount of beans eaten. While the consumption of two to three pods by a young child may not have any deleterious impact, a large quantity can lead to serious morbidity and even death [62, 63].

Since some children eat very few beans and remain asymptomatic, people tend to consider the beans as non-toxic. With a larger 'dose', such as the beans in six to seven pods, they develop a non-fatal illness with vomiting, diarrhea, malaise, giddiness, drowsiness, change in voice and general weakness among other effects. However, recovery occurs after about 3–4 days of illness. The fatal hepatomyoencephalopathy syndrome may occur with relatively larger amount of beans—such as the cupped hand of a child [63].
