Abstract
The South American shamanic Kambô ritual involves applying the skin secretions of Phyllomedusa bicolor (giant monkey frog) to superficial burns for purported spiritual and therapeutic benefits. These secretions contain a complex mix of bioactive peptides, such as phyllocaerulein, phyllomedusin, phyllokinin, sauvagine, dermorphins, and deltorphins, that interact with diverse neurotransmitter and hormone receptor systems. Specifically, these peptides engage cholecystokinin (CCK) receptors, neurokinin-1 (NK1) receptors, bradykinin B2 receptors, corticotropin-releasing factor (CRF) receptors, and opioid receptors (μ and δ subtypes), influencing gastrointestinal, cardiovascular, endocrine, and neurologic pathways. While often short-lived, these peptides provoke profound physiological disturbances, including violent emesis, vasodilation, fluid shifts, and antidiuretic hormone (ADH) dysregulation. The combination of these effects with ritualistic overhydration of water can trigger life-threatening hyponatremia, cerebral edema, and ultimately, brain death. We present the first documented case of brain death associated with Kambô toxicity. A 35-year-old female developed headache, emesis, and unilateral fixed and dilated pupil within hours of a Kambô ritual. Imaging demonstrated diffuse cerebral edema and loss of intracranial blood flow. Laboratory workup revealed severe hyponatremia, likely due to excessive water intake, peptide-induced emesis with sodium loss, and suspected SIADH. Despite aggressive medical management, the patient progressed to brain death. Kambô rituals are unregulated and increasingly practiced in Western countries despite a lack of medical oversight. The ritual's unique combination of cutaneous toxin delivery, extreme emesis, and excessive water hydration creates a perfect storm for acute symptomatic hyponatremia and cerebral herniation. Physicians should consider Kambô exposure in patients presenting with acute neurologic decline and dot-like burn patterns. Public awareness, clinician education, and the development of treatment algorithms are critical as the use of this neurotoxic ritual continues to expand.