Simultaneous death of two siblings, a Senna matter?

Senna is a medicinal herb commonly used as a laxative and dietary aid for weight loss. Repeated consumption of Senna may lead to persistent diarrhea. Furthermore, cases of acute liver failure and hepato-encephalopathic syndrome after chronic Senna ingestion were reported in literature. In this situation, this manuscript aims to report and discuss two simultaneous fatalities putatively related to Senna repeated ingestions with analytical documentation. Two siblings in their thirties, who had no notable medical history except being overweight, passed away within two days of each other. Their family revealed that they had been regularly consuming Senna for weight loss purposes. Samples of leaves, supposed to be Senna, were analyzed and the identification of Senna was confirmed by detecting its main component (sennosides). Moreover, analyses of samples from siblings confirmed the effectiveness of Senna consumption by detection of Senna related substances (rheinanthrone and aloe-emodine) in urine, bile and feces. In view of these results, rheinanthrone and aloe-emodin can be suggested as analytical targets, particularly in urine, as biomarkers of Senna exposure. In these two fatalities, analytical data and metabolism studies confirmed use, but not necessarily toxicity. However, on a forensic point of view, the similarities in symptoms and the surprising simultaneity of the clinical events leading to fatalities suggest Senna exposure as the main hypothesis to explain these simultaneous deaths.