Kambô Intoxication for the Intensivist – Part 1

Jon-Emile S. Kenny MD [@heart_lung]

“All things are poisons, for there is nothing without poisonous qualities. It is only the dose which makes a thing poison.”

-Paracelsus

Background

Per one account, many living in the village Kaxinauá were seriously-ill and the shaman could not help them with known herbal medicines. During a ritual involving ayahuasca, the shaman received a message to enter the forest. With this instruction, he discovered a deity holding a green frog and learned how to shave secretions from the frog for medicinal purposes. His efforts were successful and this practice became routine in Kaxinauá and amongst other tribes; this ritual is centuries old.

The frog is referred to colloquially as Kambô, Kampo or Kampu and, scientifically, as Phyllomedusa bicolor. Its habitat is around streams and trees of the Amazon rainforest. It is a striking, nocturnal animal with large, ashen eyes, an intense, waxy, lime dorsum and butter-yellow belly. Along the border of its two distinct colours are a smattering of conspicuous, neon-white freckles thinly-outlined in black.

In addition to ‘Kambô’, the secretion obtained from the frog is sometimes referred to as ‘toad vaccine’ or ‘sapo,’ which is Spanish for toad. To this end, the shaman ties each leg of the frog and pulls them outwards forming an x-shape; this is done near an open flame and the frog’s back and legs are shaved with a wooden stick which is left to dry. It is considered disrespectful and bad luck to harm the frog; it is carefully returned to its habitat after collection.

Application and Effects

Kambô is applied trans-dermally through multiple, small [< 5-10 mm], superficial, circular burns made by a stick or small section of vine called ‘titica.’  Reportedly, men are typically burned on their right arm or upper chest, while women on their right heel or calf. The number and arrangement of the burns vary. In one investigation of 22 kambô recipients, the average number of burns was 7 ± 2; in many of the case reports the circular burns are in linear formation, though this is not universal.

Almost immediately after application, the individual feels warm and this is met with violent gastrointestinal duress including nausea, vomiting and diarrhea. There may be swelling of the face [often peri-orbital], intense sweating and tachycardia. Usually after 15 to 60 minutes, the user returns to baseline with a sense of well-being and security.

Ultimately, kambô is thought to purify the spirit, increase physical strength, sexual stamina, augment hunting success and ward off ‘panema’ [bad luck or suffering of the mind]. In western, urban settings, the ritual is being used to promote wellness, treat depression and substance abuse among other things.

The appropriation of this ritual by urbanites may represent dissatisfaction with the positivistic approach of western medicine. Importantly, within indigenous communities, there is a long, cultural tradition that affords safety as generations of knowledge are accumulated by local healers. Some shamans warn of kambô misuse, as inexperience leads to adverse events. As well, acquiring kambô beyond traditional channels may entail internet commerce with little regulation of how the kambô is collected, its purity or provenance. Further, incorrect recommendations on peri-ritual diet, water intake and interaction with medical co-morbidities can associate with adverse events, as described below.

Plethora of Peptides

Fundamentally, the secretions of P. bicolor are an evolutionary adaptation meant to thwart predators. The residue is a concoction of multiple, biologically-active peptides with a variety of biochemical actions – some of which explain the symptoms described above and adverse events below.  Presumably, the peptides are absorbed locally via lymph at the burn site and then reach the blood stream. Early characterization of these peptides was done by Erspamer and colleagues in the 1960s; there at least 7 known.

Dermorphin and deltorphin are heptapeptides that have affinity for opioid receptors and demonstrated behavioural changes and analgesic effects in murine models. They are often reported to be many more times potent than morphine, but because of suboptimal pharmacokinetics, they are effectively comparable to morphine.

Phyllocaerulin or its analogue caerulein, may trigger endorphin release leading to diminished hunger, thirst and analgesia. Further, it has similar structure and action to cholecystokinin which secretes digestive enzymes, stimulates smooth muscle contraction contributing to nausea, vomiting and diarrhea.

Phyllomedusin is a tachykinin and phyllokinin is a bradykinin both of which cause hypotension. As well, phyllomedusin is a physalaemin-like peptide that may release antidiuretic hormone.

Sauvagine is a neuropeptide that has a multitude of effects including endorphin, corticosteroid, catehcholamine and glucose release. It may lead to hypotension, tachycardia and profound mesenteric vasodilation which may contribute to diarrhea via vasodilation of intestinal walls. Increased plasma corticosteroid levels in rat models and may explain the reported sensation of increased strength and stamina experienced during the later phase of intoxication.

Dermaseptin is another peptide found in Phyllomedusae secretions that has yet undefined antimicrobial effects. Interestingly, there are reports that they have anti-pseudomonal and anti-parasitic effects [e.g., Trypanosoma cruzi] as mentioned in the case summary by de la Vega and colleagues.

With cursory historical and biochemical backgrounds described above, a brief, second part on kambô is offered next. This follow-up will summarize a handful of case reports with emphasis on the commonly-observed gastrointestinal, electrolyte, laboratory and hemodynamic derangements.

Read part 2 here.

Best,

JE

Dr. Kenny is the cofounder and Chief Medical Officer of Flosonics Medical; he is also the creator and author of a free hemodynamic curriculum at heart-lung.org.  Download his free textbook here.