Severe red kidney beans toxicity in an 8-year-old girl: a rare case of hypovolemic shock and prerenal acute kidney injury

Abstract

Red kidney beans (Phaseolus vulgaris) contain high levels of the lectin phytohaemagglutinin (PHA). Ingestion of raw or insufficiently cooked beans can cause acute toxicity, with symptoms typically arising 1–3 h after consumption. While most cases produce transient nausea, vomiting, and diarrhea, severe outcomes including hypovolemic shock and acute kidney injury (AKI) are rare. An 8-year-old girl developed loss of consciousness, profound hypotension, and bradycardia after ingesting a home-cooked red kidney bean dish. She required cardiopulmonary resuscitation (CPR) and intensive fluid resuscitation. Laboratory findings indicated dehydration and prerenal azotemia (BUN/creatinine ratio ≈ 33:1). A follow-up serum creatinine 24 h after admission was 0.5 mg/dL. After aggressive supportive care, she regained consciousness, and renal function recovered. Treatment was entirely supportive, consisting of airway management, intravenous crystalloids (20 mL/kg boluses), and gastrointestinal protection. No specific antidote exists for PHA. The patient improved over the course of hours, with normalization of vital signs and renal parameters. This case highlights an unusual presentation of red kidney bean lectin poisoning manifesting as shock and prerenal AKI. Clinicians should consider undercooked bean ingestion in children with sudden gastroenteritis and shock. Prompt fluid resuscitation is effective, and complete recovery is expected with supportive care.