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LEMON GRASS OIL

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Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) Lemon grass oil is a volatile oil obtained by distillation from Cymbopogon flexuosus or Cymbopogon citratus.

Specific Substances

    1) Essencia de Capim-Limaco
    2) Indian Melissa Oil
    3) Indian Verbena Oil
    4) Oleum Gramninis Citrati
    5) Citral
    6) 3,7-dimethyl-2,6-octaidienal

Available Forms Sources

    A) FORMS
    1) Lemon grass oil is obtained from Cymbopogon citratus or Cymbopogon flexuosus which are found in Ceylon and Southern India. These plants have also gone under the genus name of Andropogon (JEF Reynolds , 2000; Mitchell & Rook, 1979).
    2) Lemon grass oil contains 75% to 85% of the aldehyde citral and small amounts of citronellal, methylheptenone, geraniol, limonene, and dipentene (Budavari, 1996).
    B) USES
    1) Although formerly used as a carminative, lemon grass oil is now mostly used in the perfume industry, as a flavor in the food industry, and in the manufacture of vitamin A (JEF Reynolds , 2000; Budavari, 1996). It also has rubefacient properties (Behl et al, 1966).

Overview

Life Support

    A) This overview assumes that basic life support measures have been instituted.

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) USES: Lemon grass oil has rubefacient properties. Although formerly used as a carminative, lemon grass oil is now mostly used in the perfume industry, as a flavor in the food industry, and in the manufacture of vitamin A.
    B) PHARMACOLOGY: Lemon grass oil is a volatile oil obtained from Cymbopogon citratus or Cymbopogon flexuosus which are found in Ceylon and Southern India. These plants have also gone under the genus name of Andropogon. Lemon grass oil contains 75% to 85% of the aldehyde citral and small amounts of citronellal, methylheptenone, geraniol, limonene, and dipentene.
    C) EPIDEMIOLOGY: Exposures are common. Lemon grass oil has relatively low acute systemic toxicity.
    D) WITH POISONING/EXPOSURE
    1) Lemon grass oil may be an aspiration risk, but has relatively low acute systemic toxicity. The primary reported effect is irritation, especially contact or allergic dermatitis. Citral (the main constituent of lemon grass oil) is a primary skin irritant and sensitizing agent in concentrations of greater than 8%. It may be irritating to the mucous membranes of the mouth and throat. It may also have a sedative effect.
    0.2.20) REPRODUCTIVE
    A) Teratogenicity has been reported in animals but not in humans. Reduction of the number of follicles secondary to oocyte degeneration was reported in one study in rats.

Laboratory Monitoring

    A) No specific laboratory tests are necessary unless otherwise clinically indicated.
    B) Monitor vital signs and mental status in symptomatic patients.
    C) Patch testing may identify sensitized individuals.

Treatment Overview

    0.4.2) ORAL/PARENTERAL EXPOSURE
    A) MANAGEMENT OF TOXICITY
    1) Treatment is symptomatic and supportive. Although CNS depression has been reported in humans and animals, coma has not yet been observed. Monitor for CNS depression and respiratory depression or distress. If the patient is already coughing upon arrival, it is likely aspiration has already occurred. Monitor arterial blood gases in cases of severe aspiration pneumonitis to assure adequate ventilation.
    B) DECONTAMINATION
    1) Gastrointestinal decontamination is not recommended because of the risk of aspiration. Remove contaminated clothing and wash exposed skin with soap and water. Irrigate all areas contacted by lemon grass oil with cool water. Warm or hot water may increase the incidence and severity of dermal reactions. Irrigate exposed eyes.
    C) AIRWAY MANAGEMENT
    1) Should not be required in these cases. Ensure adequate ventilation and perform endotracheal intubation early in patients with significant CNS depression.
    D) ANTIDOTE
    1) None.
    E) PATIENT DISPOSITION
    1) HOME CRITERIA: Patients with small inadvertent exposures who have minimal symptoms (mild gastrointestinal upset or mucosal irritation) may be managed at home.
    2) OBSERVATION CRITERIA: Patients with more than mild symptoms and those with deliberate or large ingestions should be sent to a healthcare facility. Patients should be observed in a medical facility until free of symptoms.
    3) ADMISSION CRITERIA: Patients who remain symptomatic despite treatment should be admitted.
    4) CONSULT CRITERIA: Consult a Poison Center or medical toxicologist for assistance in managing patients with severe toxicity or for whom diagnosis is unclear.
    F) PITFALLS
    1) Failure to consider potential toxicity from other substances in preparations containing essential oils. Severe toxicity is not common, do not overtreat.
    G) DIFFERENTIAL DIAGNOSIS
    1) Exposure to solvents or hydrocarbons
    0.4.4) EYE EXPOSURE
    A) DECONTAMINATION: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 0.9% saline or water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist after 15 minutes of irrigation, the patient should be seen in a healthcare facility.
    0.4.5) DERMAL EXPOSURE
    A) OVERVIEW
    1) Remove contaminated clothing and wash exposed skin with soap and water. Irrigate all areas contacted by lemon grass oil with cool water. Warm or hot water may increase the incidence and severity of dermal reactions.

Range Of Toxicity

    A) TOXICITY: A human toxic dose for citral has not been established. Citral 500 mcg/kg has been used therapeutically.

Clinical Effects

Summary Of Exposure

    A) USES: Lemon grass oil has rubefacient properties. Although formerly used as a carminative, lemon grass oil is now mostly used in the perfume industry, as a flavor in the food industry, and in the manufacture of vitamin A.
    B) PHARMACOLOGY: Lemon grass oil is a volatile oil obtained from Cymbopogon citratus or Cymbopogon flexuosus which are found in Ceylon and Southern India. These plants have also gone under the genus name of Andropogon. Lemon grass oil contains 75% to 85% of the aldehyde citral and small amounts of citronellal, methylheptenone, geraniol, limonene, and dipentene.
    C) EPIDEMIOLOGY: Exposures are common. Lemon grass oil has relatively low acute systemic toxicity.
    D) WITH POISONING/EXPOSURE
    1) Lemon grass oil may be an aspiration risk, but has relatively low acute systemic toxicity. The primary reported effect is irritation, especially contact or allergic dermatitis. Citral (the main constituent of lemon grass oil) is a primary skin irritant and sensitizing agent in concentrations of greater than 8%. It may be irritating to the mucous membranes of the mouth and throat. It may also have a sedative effect.

Heent

    3.4.3) EYES
    A) WITH POISONING/EXPOSURE
    1) INCREASED INTRAOCULAR PRESSURE: Citral has been alleged to increase intraocular pressure in animals, but this effect has yet to be confirmed in man (Grant & Schuman, 1993).
    3.4.6) THROAT
    A) WITH POISONING/EXPOSURE
    1) IRRITATION: May irritate the mucous membranes of the mouth and throat (Mendelsohn, 1944).

Cardiovascular

    3.5.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) VASCULAR DISORDER
    a) Animal studies have demonstrated damage to vascular endothelia. Blood vessel damage has been postulated, but not seen in man (Leach & Lloyd, 1956).

Neurologic

    3.7.2) CLINICAL EFFECTS
    A) CENTRAL NERVOUS SYSTEM DEFICIT
    1) WITH POISONING/EXPOSURE
    a) Citral, and especially citronellal, has a sedative effect. Citral diminishes neuron excitability, so that large doses may decrease seizure potential; the doses necessary are too large to be used in man (Sollmann, 1957).

Hepatic

    3.9.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) HEPATIC ENZYMES INCREASED
    a) Citral caused a 25% increase in liver enzyme activity and cytochrome P-450 concentration when given IP to rats for 3 days (Parke & Rahman, 1969).

Hematologic

    3.13.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) HEMOLYSIS
    a) Citral caused erythrocyte hemolysis when administered in low and high concentrations. This effect has not yet been reported in man (Tamir et al, 1984).

Dermatologic

    3.14.2) CLINICAL EFFECTS
    A) SKIN IRRITATION
    1) WITH POISONING/EXPOSURE
    a) Citral is a primary skin irritant and sensitizing agent. The undiluted oil is an irritant when patch tested (Mendelsohn, 1944).
    b) Citral concentrations less than 8% seldom caused skin irritation (Thomas & Pasternak, 1969).
    c) Heat may play an important role in reactions to citral. One study reported several cases of temperature dependant toxic dermatitis caused by a citral containing dishwashing detergent (Rothenborg et al, 1977).
    B) BULLOUS ERUPTION
    1) WITH POISONING/EXPOSURE
    a) CASE SERIES: Eight workers who were exposed when on a ship carrying lemon grass oil developed vesicular dermatitis of the face, forearms, and ankles (Mendelsohn, 1944).
    3.14.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) SEBORRHEA
    a) When a 15.4% solution of citral was applied to rat skin daily for 3 months, there were increases in the number of sebaceous glandlobules and hyperplasia of sebaceous cells (Abramovici et al, 1982).

Immunologic

    3.19.2) CLINICAL EFFECTS
    A) ACUTE ALLERGIC REACTION
    1) WITH POISONING/EXPOSURE
    a) Sensitization is thought to occur to the oil (Greenberg & Lester, 1954; Mendelsohn, 1944).
    b) CASE REPORT: Contact dermatitis was reported in a bartender secondary to contact with citrus peel oil which contained geraniol and citral. The patient had no history of atopy or psoriasis (Cardullo et al, 1989).

Reproductive

    3.20.1) SUMMARY
    A) Teratogenicity has been reported in animals but not in humans. Reduction of the number of follicles secondary to oocyte degeneration was reported in one study in rats.
    3.20.2) TERATOGENICITY
    A) ANIMAL STUDIES
    1) Teratogenicity has been reported in animals (Tamir et al, 1984) but not in humans.
    2) Reduction of the number of follicles secondary to oocyte degeneration was reported in one study in rats.
    a) Doses were 300 mg/kg IP on the day of proestrus for 6 cycles, or 460 mg/kg/day (in ethanol) applied dermally (Toaff et al, 1979).

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) No specific laboratory tests are necessary unless otherwise clinically indicated.
    B) Monitor vital signs and mental status in symptomatic patients.
    C) Patch testing may identify sensitized individuals.
    4.1.2) SERUM/BLOOD
    A) OTHER
    1) No specific laboratory tests are necessary unless otherwise clinically indicated.
    4.1.4) OTHER
    A) OTHER
    1) DERMAL
    a) Patch testing may identify sensitized individuals (Mendelsohn, 1944).

Treatment

Life Support

    A) Support respiratory and cardiovascular function.

Patient Disposition

    6.3.1) DISPOSITION/ORAL EXPOSURE
    6.3.1.1) ADMISSION CRITERIA/ORAL
    A) Patients who remain symptomatic despite treatment should be admitted.
    6.3.1.2) HOME CRITERIA/ORAL
    A) Patients with small inadvertent exposures who have minimal symptoms (mild gastrointestinal upset or mucosal irritation) may be managed at home.
    6.3.1.3) CONSULT CRITERIA/ORAL
    A) Consult a Poison Center or medical toxicologist for assistance in managing patients with severe toxicity or for whom diagnosis is unclear.
    6.3.1.5) OBSERVATION CRITERIA/ORAL
    A) Patients with more than mild symptoms and those with deliberate or large ingestions should be sent to a healthcare facility. Patients should be observed in a medical facility until free of symptoms.

Monitoring

    A) No specific laboratory tests are necessary unless otherwise clinically indicated.
    B) Monitor vital signs and mental status in symptomatic patients.
    C) Patch testing may identify sensitized individuals.

Oral Exposure

    6.5.1) PREVENTION OF ABSORPTION/PREHOSPITAL
    A) Gastrointestinal decontamination is not recommended because of the risk of aspiration. Remove contaminated clothing and wash exposed skin with soap and water. Irrigate all areas contacted by lemon grass oil with cool water. Warm or hot water may increase the incidence and severity of dermal reactions. Irrigate exposed eyes.
    6.5.2) PREVENTION OF ABSORPTION
    A) Gastrointestinal decontamination is not recommended because of the risk of aspiration.
    6.5.3) TREATMENT
    A) SUPPORT
    1) MANAGEMENT OF TOXICITY
    a) Treatment is symptomatic and supportive. Although CNS depression has been reported in humans and animals, coma has not yet been observed. Monitor for CNS depression and respiratory depression or distress. If the patient is already coughing upon arrival, it is likely aspiration has already occurred. Monitor arterial blood gases in cases of severe aspiration pneumonitis to assure adequate ventilation.
    B) MONITORING OF PATIENT
    1) No specific laboratory tests are necessary unless otherwise clinically indicated.
    2) Monitor vital signs and mental status in symptomatic patients.
    3) Patch testing may identify sensitized individuals.
    C) EXPERIMENTAL THERAPY
    1) Animal experiments have had success using the following therapy, but it has not been necessary or tried in human cases (Leach & Lloyd, 1956):
    2) Administration of sulfhydryl compounds
    a) N-acetylcysteine
    b) Cysteine
    c) Uramino-cysteine
    d) O-aminiothophenol
    3) Sulfydryl blockers
    a) P-chloromercuribenzoic acid
    4) Aldehyde-trapping agents
    a) Hydroxylamine
    b) Sodium bisulphite
    5) Vitamin A

Eye Exposure

    6.8.1) DECONTAMINATION
    A) EYE IRRIGATION, ROUTINE: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 0.9% saline or water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist after 15 minutes of irrigation, an ophthalmologic examination should be performed (Peate, 2007; Naradzay & Barish, 2006).
    6.8.2) TREATMENT
    A) RAISED INTRAOCULAR PRESSURE
    1) Citral has been alleged to increase intraocular pressure in animals, but this effect has yet to be confirmed in man (Grant, 1986).
    B) Treatment should include recommendations listed in the ORAL EXPOSURE section when appropriate.

Dermal Exposure

    6.9.1) DECONTAMINATION
    A) DERMAL DECONTAMINATION
    1) Irrigate all areas contacted by lemon grass oil with cool water. Warm or hot water may increase the incidence and severity of reactions in some individuals (Rothenborg et al, 1977).

Range Of Toxicity

Summary

    A) TOXICITY: A human toxic dose for citral has not been established. Citral 500 mcg/kg has been used therapeutically.

Therapeutic Dose

    7.2.1) ADULT
    A) GENERAL
    1) THERAPEUTIC DOSE - 500 micrograms/kilogram is an acceptable daily intake for citral (Osol & Farrar, 1955).

Maximum Tolerated Exposure

    A) Citral 500 mcg/kg has been used therapeutically (Osol & Farrar, 1955).
    B) ANIMAL STUDIES
    1) If humans were as sensitive to the vascular effects produced in animals, 50 mcg might cause vascular damage. Two grams of orange peel contains 50 mcg of citral, so it is unlikely humans have this extreme sensitivity (Leach & Lloyd, 1956). The exact relationship of this vascular damage data to humans has yet to be established.
    2) Tests by Wagner and Sprinkmeyer (1973) shows that citral and citronellal in the combination product Melissengeist (Spirit of Carmelite) had sedative properties in doses of 1 to 31.6 mg/kg. This study was not well controlled, thus the wide dose range.
    3) 5 mcg/kg of citral orally or subcutaneous to rabbits caused damage to the vascular endothelia. Monkeys: Vascular damage was caused at an oral or subcutaneous dose of 1 mcg/kg/day (for 3 wk). Larger doses caused severe diarrhea (Leach & Lloyd, 1956).
    4) Rats: A dose of 300 mg/kg IP showed no apparent toxic effect. The same was true of 460 mg/kg (in ethanol) given dermally(Toaff et al, 1979)

Toxicity Information

    7.7.1) TOXICITY VALUES
    A) LD50- (INTRAPERITONEAL)RAT:
    1) 460 mg/kg -- in olive oil (Toaff et al, 1979)

Physicochemical

Physical Characteristics

    A) This substance has a strong verbena-like odor, and is reddish-yellow to brownish-yellow in color.

Molecular Weight

    A) Varies

References

General Bibliography

    1) Abramovici A, Wolff R, & Sandbank M: Sebaceous glands changes following topical application of citral. Acta Derm Venereol 1982; 63:428-431.
    2) Anon: Twenty-third report of Joint FAO/WAO Expert Committee on Food Additives. Tech Rep Ser, No. 648, World Health Organization, Geneva, Switzerland, 1980.
    3) Behl PN, Captain RM, & Bedi BMS: Skin irritant and sensitizing plants found in India, New Delhi, PN Behl, Irwin Hospital, New Delhi, India, 1966.
    4) Budavari S: The Merck Index, 12th ed, Merck & Co, Inc, Whitehouse Station, NJ, 1996.
    5) Cardullo AC, Ruszkowski AM, & DeLeo VA: Allergic contact dermatitis resulting from sensitivity to citrus peel, geraniol, and citral. J Am Acad Dermatol 1989; 21:395-397.
    6) Grant WM & Schuman JS: Toxicology of the Eye, 4th ed, Charles C Thomas, Springfield, IL, 1993.
    7) Grant WM: Toxicology of the Eye, 3rd ed, Charles C. Thomas, Springfield, IL, 1986.
    8) Greenberg LA & Lester D: Handbook of Cosmetic Materials, Interscience, New York, NY, 1954.
    9) JEF Reynolds : Martindale: The Extra Pharmacopoeia (electronic version). The Pharmaceutical Press. London, UK (Internet Version). Edition expires 2000; provided by Truven Health Analytics Inc., Greenwood Village, CO.
    10) Leach EH & Lloyd: Citral poisoning. Proc Nutr Soc 1956; 15:15-16.
    11) Mendelsohn HV: Dermatitis from lemon grass oil (Cymbopogon citratus or Andropogon citratus). Arch Derm Syph 1944; 50:34.
    12) Mitchell & Rook A: Botanical Dermatology, Greengrass, Vancouver, BC, 1979.
    13) Naradzay J & Barish RA: Approach to ophthalmologic emergencies. Med Clin North Am 2006; 90(2):305-328.
    14) Osol A & Farrar GE: The Dispensatory of the United States of America, 25th edition, JB Lippincott Company, Philadelphia, PA, 1955, pp 750.
    15) Parke DV & Rahman H: The effects of some terpenoids and other dietary nutrients on hepatic drug metabolizing enzymes. Biochem J 1969; 113.
    16) Peate WF: Work-related eye injuries and illnesses. Am Fam Physician 2007; 75(7):1017-1022.
    17) Rothenborg HW, Menne T, & Sjolin KE: Temperature dependent primary irritant dermatitis from lemon perfume. Contact Dermatitis 1977; 3:37-48.
    18) Sollmann T: A manual of pharmacology, 8th edition, WB Saunders Company, Philadelphia, PA, 1957.
    19) Tamir I, Abramovici A, & Milo-Goldzweig I: The hemolytic activity of citral: evidence for free radical participation. Biochem Pharmacol 1984; 33:2945-2950.
    20) Thomas DB & Pasternak CA: Vitamin A and the biosynthesis of sulfphated mucopolysaccharides. Experiments with rats and cultural neoplastic mast cells. Biochem J 1969; 111:407-412.
    21) Toaff ME, Abramovici A, & Sporn J: Selective oocyte degeneration and impaired fertility in rats treated with the aliphatic monoterpene citral. J Reprod Fert 1979; 55:347-352.