The dried venom of the Chinese toad (Bufo bufo gargar-izans) is one of the ingredients of the traditional Chinese medicine kyushin. It has been used as an aphrodisiac and contains the bufadienolides bufalin and cinobufaginal, which are structurally related to cardenolides, such as digoxin, and create the false impression of high plasma digoxin concentrations (54). Digoxin Fab fragments have therefore been used to treat toad venom poisoning (55).
Poisoning with toad venom presents like digitalis toxicity (56). A deliberate overdose of kyushin in an attempt to commit suicide resulted in nausea, vomiting, general malaise, and electrocardiographic changes (for example atrioventri-cular block) (57). Fatal poisoning with toad venom presented with gastrointestinal symptoms, severe bradycardia, hyper-kalemia, acidosis, and cardiac dysrhythmias (58).
The Chinese medicine Ch'an su, which is derived from dried toad venom, also contains bufalin and cinobufagi-nal, and has repeatedly been linked with serious, even fatal, cardiotoxicity (59).
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