First – let me start with the disclaimer that Catherine is okay. Fortunately ingesting seeds rarely results in acute toxicity.
One afternoon last week, I gave the girls each half of a Sugar Apple (also known as a Sweetsop or Custard Apple) as a snack. They’ve eaten these many times without incident but this time, while I turned away to hand Charlotte her half, Catherine gulped down her half without removing the seeds. I was shocked to hear “I still hungry” and turn around to discover that she’d already eaten her entire half. Seeds and all. 15 seconds. The fact that she ate the seeds should have distressed me more than it did. I was worried about her digestion but I should have been worried about hydrogen cyanide poisoning (I had no clue). If you’ve heard that apple seeds are poisonous this is the same idea – the seeds contain amygdalin which converts to hydrogen cyanide during digestion. There’s not a lot of amygdalin in each seed but Catherine doesn’t have the body mass of an adult either.
A day later, in the afternoon, Catherine seemed subdued and complained of being cold. The cool season has just begun and the temperatures has gotten as low as 76°. We gave her a lot of TLC but didn’t think more of it then.
The next morning Catherine was clingy and again complained about being cold. She put my hand on her belly and told me it was cold. Then she said she was hungry and asked for a snack. As I cut a cucumber into quarters for her she started to cry and then vomited up her breakfast. She then looked up at me and said factually, “I pooped all over the floor.” I explained that it was ‘throw up’ or ‘vomit’, not poop, as I cleaned her (I tried to comfort her but she wasn’t really upset). She found this very interesting and asked many follow-up questions. We thought she had food poisoning but, fortunately, already had an appointment scheduled at the clinic to follow up on Charlotte’s heel injury.
It turns out that swallowing the Sugar Apple seeds gave Catherine mild cyanide poisoning. This would have been more serious if she had chewed up the seeds (which are very hard) instead of swallowing them whole. She didn’t get the full dose of amygdalin from the seeds and the hydrogen cyanide quickly metabolized into thiocyanate in 10-30 minutes. The thiocyanate has a half life of around 24 hours in the human body and was responsible for most of her symptoms. Basically, Catherine was through the worst of it by the time we understood what had happened.
Many things, such as Dengue fever and food poisoning, were on my list of parenting in Cambodia concerns. Cyanide poisoning from fruit seeds was not one of them…but it is now.