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 Table of Contents  
LETTERS TO THE EDITOR
Year : 2018  |  Volume : 6  |  Issue : 2  |  Page : 304-305

High dose of black seed oil: Unusual case of abdominal pain


1 King Abdullah International Medical Research Center; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences; Department of Pediatrics, King Abdulaziz Medical City – Western Region, Ministry of the National Guard – Health Affairs, Jeddah, Saudi Arabia
2 King Abdullah International Medical Research Center; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City – Western Region, Jeddah, Saudi Arabia

Date of Web Publication27-Dec-2018

Correspondence Address:
Dr. Hani Almalki
King Saud Bin Abdulaziz University For Health Sciences, King Abdulaziz Medical City – Western Region, Jeddah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_48_18

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How to cite this article:
Baothman AA, Almalki H. High dose of black seed oil: Unusual case of abdominal pain. Arch Med Health Sci 2018;6:304-5

How to cite this URL:
Baothman AA, Almalki H. High dose of black seed oil: Unusual case of abdominal pain. Arch Med Health Sci [serial online] 2018 [cited 2019 Jan 20];6:304-5. Available from: http://www.amhsjournal.org/text.asp?2018/6/2/304/248667



Sir,

Nigella sativa (NS) is a well-known traditional herbal plant known by various common names, including black cumin and black seed. NS seed oil (NSO) is consumed as a protective health remedy and is thought to enhance immunity. However, the effect of NSO on hemostasis is controversial.

Hereby, we describe a case of a 57-year-old man known to have Type II diabetes mellitus for 10 years on insulin therapy, developed acute severe abdominal pain and constipation 7 days before admission. The patient had been ingesting NSO at doses 10 g daily for almost 3 weeks. The patient obtained the NSO from a local herbal shop and it was not branded. An urgent computed tomography image of his abdomen with contrast displayed extensive thromboses of the main portal vein, main right, and left intrahepatic branches and splenic and superior mesenteric veins [Figure 1]a,[Figure 1]b,[Figure 1]c. Laboratory tests showed slightly low platelet count (144,000/μL), normal liver function test, normal amylase level, and normal cardiac enzymes. Coagulation testing revealed short activated partial thromboplastin time (APTT) at 25 s (normal range 30–50 s), normal thrombin time (TT) at <22 sec, the international normalized ratio at 1.0, and prothrombin time (PT) at 11 s. In addition, antithrombin III, protein C and S levels, and factor V were all normal. Antilupus anticoagulant and Janus kinase 2 were not detected. Due to the lack of necessary laboratory equipment, chemical analysis of the ingested NSO was not performed. The diagnosis was made based on the patient's history of ingestion of an extremely high dose of NSO, 10 g/daily for 3 weeks. The patient responded to anticoagulation therapy with unfractionated heparin. We believe that the development of acute portal venous thrombosis was largely due to the patient's large consumption of NSO constituents.
Figure 1: (a) Computed tomography abdomen (coronal section) with contrast showed a superior mesenteric vein thrombosis. (b) Computed tomography abdomen with contrast showed a main portal vein and splenic thrombosis. (c) Computed tomography abdomen with contrast showed a right hepatic vein thrombosis

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Black seed fixed oil has a wide margin of safety if taken in therapeutic doses. A study showed the high lethal oral dose in rats was 28.8 ml/kg body weight, which suggests a low toxicity of black seed oil.[1] In addition, a study performed on type II diabetic patients who consumed more than 2 g/day of NS supplements for 12 weeks showed an improvement in systolic and diastolic blood pressure and heart rate.[2] Several in vivo and in vitro beneficial pharmacological effects, including antioxidant, hypoglycemic, antihypertensive, antimicrobial, mast cell stabilizing, anti-inflammatory, anticarcinogenic and antihistaminergic effects, and hypocholesterolemic effects in patients with hypercholesterolemia and hyperlipidemia, have been linked to use of various components of black seed powder, oil, or extracts.[3],[4],[5]

The effect of NS and its constituents on hemostasis have been studied in rats, but there are few studies in humans. With normal and therapeutic doses of thymoquinone at a dose of 0.6 mg/kg/day orally, NSO constituents have anticoagulant and fibrinolytic effects.[6] Based on laboratory studies, various components of NSO, such as thymol, have very strong inhibitory effects on platelet aggregation and blood coagulation through inhibition of arachidonic acid, suggesting that NSO is a fibrinolytic agent.[7],[8] In another study, NSO was shown to increase tissue plasminogen activator in endothelial cells, indicating that NSO modulates the balance of thrombus/fibrinolysis development by stimulating the fibrinolytic sites of endothelial cells.[9] In male albino rats, NSO induced hyperfibrinogenemia, transient PT prolongation, TT shortening, transient APTT shortening and an increase in liver enzymes.[10] Lebda et al. showed that following the administration of more than 2 g/day of NS supplementation along with the improvement of glycemic control reported an increased in the fibrinogen levels.[2] This could be a risk factor, which might have contributed to the extensive thrombosis in the index patient. Although the role of NS supplementation in increasing thrombosis in our patient is not clear, the previous study showed a favorable impact on hemodynamic parameters including blood pressure, heart rate, and mean arterial pressure following the ingestion of 2 g/day of black seeds for 12 weeks.[2] In the case reported here, the acute development of extensive intraabdominal venous thrombosis in a fairly healthy patient, in the absence of thrombophilic risk factors, could be an unwanted side effect of excessive consumption of extremely high dose of NSO.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zaoui A, Cherrah Y, Mahassini N, Alaoui K, Amarouch H, Hassar M. Acute and chronic toxicity of Nigella sativa fixed oil. Phytomedicine 2002;9:69-74.  Back to cited text no. 1
    
2.
Lebda FM, Bamosa AO, Kaatabi H, Al Elq A, Al-Sultan A. Effect of Nigella sativa on hemodynamics, hemoglobin, and blood coagulation in patients with type 2 diabetes. Egypt J Haematol 2012;37:73-80.  Back to cited text no. 2
  [Full text]  
3.
el-Dakhakhny M. Studies on the Egyptian Nigella sativa L. IV. Some pharmacological properties of the seeds' active principle in comparison to its dihydro compound and its polymer. Arzneimittelforschung 1965;15:1227-9.  Back to cited text no. 3
    
4.
el Tahir KE, Ashour MM, al-Harbi MM. The cardiovascular actions of the volatile oil of the black seed (Nigella sativa) in rats: Elucidation of the mechanism of action. Gen Pharmacol 1993;24:1123-31.  Back to cited text no. 4
    
5.
Zaoui A, Cherrah Y, Alaoui K, Mahassine N, Amarouch H, Hassar M. Effects of Nigella sativa fixed oil on blood homeostasis in rat. J Ethnopharmacol 2002;79:23-6.  Back to cited text no. 5
    
6.
Rahmani AH, Alzohairy MA, Khan MA, Aly SM. Therapeutic implications of black seed and its constituent thymoquinone in the prevention of cancer through inactivation and activation of molecular pathways. Evid Based Complement Alternat Med 2014;2014:724658.  Back to cited text no. 6
    
7.
Enomoto S, Asano R, Iwahori Y, Narui T, Okada Y, Singab AN, et al. Hematological studies on black cumin oil from the seeds of Nigella sativa L. Biol Pharm Bull 2001;24:307-10.  Back to cited text no. 7
    
8.
Nemmar A, Al-Salam S, Zia S, Marzouqi F, Al-Dhaheri A, Subramaniyan D, et al. Contrasting actions of diesel exhaust particles on the pulmonary and cardiovascular systems and the effects of thymoquinone. Br J Pharmacol 2011;164:1871-82.  Back to cited text no. 8
    
9.
Awad EM, Binder BR.In vitro induction of endothelial cell fibrinolytic alterations by Nigella sativa. Phytomedicine 2005;12:194-202.  Back to cited text no. 9
    
10.
Al-Jishi SA, Abuo Hozaifa B. Effect of Nigella sativa on blood hemostatic function in rats. J Ethnopharmacol 2003;85:7-14.  Back to cited text no. 10
    


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