Recent reports have revealed the side-effect of Kambô treatment, including death. Leban et al. reported the case of a 44-year-old female in Slovenia who drank six liters of water after applying Kambô, and gradually developed nausea, vomiting, confusion, lethargy, muscle weakness and spasms, fits/convulsions, loss of consciousness, short-term memory, and developed syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Pogorzelska and Łapiński6 treated a 34-year-old male patient in Poland with a chronic history of alcohol and marijuana use, who had signs of transient hepatitis, with Kambô to maintain sobriety. Kumachev et al. also reported the case of a 32-year-old female patient who was admitted to a hospital in Canada with prolonged nausea, frequent episodes of vomiting, and abdominal discomfort eight hours after Kambô treatment. Li et al. treated a 24-year-old female at a first-aid facility in the United States with symptoms of prolonged vomiting, facial flushing, facial swelling, altered mental status, and restlessness 22 hours after using Kambô. Roy et al. also reported the case of a 33-year-old woman in the United States who presented with potential psychosis (with characteristics of paranoia, anxiety, bizarre delusions, labile humor, and panic attacks) associated with Kambô use. The sudden death of a 42-year-old overweight man with signs of coronary disease associated with the use of Kambo was reported in Italy. These authors suggested that the hypotensive effects of Kambô may have resulted in reduced myocardial perfusion and tachycardia, which led to sudden cardiac arrhythmia. In Pindamonhangaba, in the state of São Paulo (Brazil), the death of a 52-year-old man was reported shortly after the application of the Kambô by a practitioner who obtained the Kambô skin secretions from of the state of Acre. All of these complications have been reported in regions far from where Kambô is traditionally used (Western Amazon), and applied by practitioners who may not have the same experience as those who traditionally perform the ritual, and thus poses an additional health risk.
In addition to its traditional use, Kambô has spread via urban expansion into alternative therapy clinics and Brazilian Ayahuasca religions (Santo Daime and União do Vegetal) with new practitioners, called holistic and medical therapists. Natives are concerned that new practitioners may misapply Kambô or use the skin secretions of other species of amphibians (“Sapo-cururu” Rhinella marina), resulting in health complications or even death. Many people have reported the benefits of this therapy as if it were a “panacea” that is able to cure many diseases (low immunity, headache, gastritis, diabetes, blood pressure problems, cirrhosis, labyrinthitis, epilepsy, impotence, depression, cancer and AIDS). These reported benefits may increase the demand for alternative treatments like Kambô; however, evidence of its efficacy is insufficient and studies of its side effects have not been conducted. The National Sanitary Surveillance Agency has ordered the suspension of all typesofadvertisingforthisalternativetherapy,andrevealedthat there is no scientific evidence to guarantee the quality, safety, and efficacy of this treatment or its indication for any type of disease, imbalance, or treatment of any acute and chronic processes. Due to the reports of complications and death, it is necessary to caution the public on the contraindications regarding the use of Kambô such as severe cardiovascular conditions, hypotensive syndromes, and to limit water intake after the ritual, in order to reduce the risk of contracting SIADH syndrome. In addition, since Kambô is also traditionally used to induce abortions, pregnant women should not participate in this ritual. Excessive applications (overdose), and treatment of children with a lower body mass, should be avoided as mass-to-dose ratio may be relatively higher during the treatment in these two groups of patients. The secretion of P. bicolor contains several different uncharacterized toxins6. Additional studies on the pharmacological potential of amphibians are necessary, and the risk of bio-piracy should be monitored. Trafficking of these animals and their secretions, and the possible impact on the P. bicolor population in their natural habitats, should be expensively studied.'Case report The syndrome of inappropriate antidiuretic hormone secretion after giant leaf frog (Phyllomedusa bicolor) venom exposure' by Vid Leban, Gordana Kozelj and Miran Brvara in (2016) 120 Toxicon 107-109 comments
In Europe body purification and natural balance restoring rituals, including Kambô, are becoming increasingly popular. In patients with neurological symptoms and a line of body burns Phyllomedusa bicolor venom exposure should be suspected. Hyponatremia after Phyllomedusa bicolor venom exposure is the result of inappropriate antidiuretic hormone secretion.
In Europe body purification and natural balance restoring rituals are becoming increasingly popular, but an introduction of Amazonian shamanic rituals in urban Europe can result in unexpected adverse events.
A 44-year-old woman attended a Kambô or Sapo ritual in Slovenia where dried skin secretion from a giant leaf frog (Phyllomedusa bicolor) was applied to five freshly burned wounds at her shoulder. Afterwards, she drank 6 litres of water and gradually developed nausea and vomiting, confusion, lethargy, muscle weakness, spasms and cramps, seizure, decreased consciousness level and short-term memory loss. The initial laboratory tests showed profound plasma hypoosmolality (251 mOsm/kg) proportional to hyponatremia (116 mmol/L) combined with inappropriately elevated urine osmolality (523 mOsm/kg) and high urine sodium concentration (87 mmol/L) indicating a syndrome of inappropriate antidiuretic hormone secretion. The patient was treated with 0.9% sodium chloride and a restriction of water intake. Plasma osmolality and hyponatremia improved one day after venom exposure, but the symptoms disappeared as late as the third day.
In patients presenting with neurological symptoms and a line of small body burns Phyllomedusa bicolor venom exposure should be suspected. Acute symptomatic hyponatremia after Phyllomedusa bicolor venom exposure is the result of inappropriate antidiuretic hormone secretion that can be exacerbated by excessive water intake.Other works on Kambo were noted here.