Reported: Dizziness, weakness, syncope, hallucinations, abdominal cramps, nausea, GI upset, pupillary changes, hepatotoxicity, renal injury.
Toxicity: At least 24 cases of pennyroyal toxicity are in the literature, reporting fulminant hepatic failure, acute renal failure, hypoglycemia, coagulopathy, metabolic acidosis, GI hemorrhage, pulmonary congestion with consolidation, mental status changes, cerebral edema, seizures, disseminated intravascular coagulation, and death. Pennyroyal oil ingestion is treated with gastric lavage, activated charcoal, and N-acetylcysteine in patients evaluated soon after ingestion.
Case Report (Oil): A 24-year-old woman ingested pennyroyal extract for over 2 weeks and, after acute ingestion, developed abdominal cramps, chills, vomiting, syncope, cardiopulmonary arrest and multiorgan failure leading to coma and death. Exploratory laparotomy showed a hemorrhagic ectopic pregnancy (13). An 18-year old ingested 30 ml of pennyroyal oil and developed abdominal pain, vomiting, coagulopathy, and died one week later from cardiopulmonary arrest and multiple organ failure (5).
Case Report (Tea): An 8-week old boy, after ingesting 120 ml of homegrown pennyroyal mint tea to treat a suspected infection, experienced multiple organ failure, including confluent hepatocellular necrosis, kidney hemorrhage and necrosis, bilateral lung consolidation with diffuse alveolar damage and hemorrhage, and diffuse cerebral edema with acute ischemic necrosis and isolated vacuolation of the midbrain. The infant died 4 days after admission. A 6-month old boy developed acute hepatic injury, seizures, and sinus hemorrhage after regular consumption of pennyroyal tea, and recovered after 2 months of hospitalization (4).