Confirmation of oleander poisoning by HPLC/MS

Abstract

A non-fatal case of Nerium oleander (common oleander) self-poisoning in a 45-year-old female is presented. Initial symptoms were nausea and vomiting, abdominal pain, phosphenes, cardiovascular shock and sinus brady-cardia. Blood and urine were assayed for oleandrin, the major cardiac glycoside of N. oleander, using a highly specific HPLC/MS procedure. The blood concentration of oleandrin at admission was 1.1 ng/ml. This is the first report of an oleander intoxication ascertained by the mass spectrometric identification of oleandrin in blood. HPLC/MS appears to be the method of choice for the forensic-toxicological investigation of poisonings by cardiac glycosides.

A non-fatal oleander poisoning

“…The presented non-fatal case confirms the report of Tracqui et al [15], both in the mild cardiac symptoms and the level of oleandrin measured in femoral blood. In conclusion, we propose to classify an oleandrin level between 1.0 and 2.0 ng/ml as toxic blood plasma/serum concentration.…”

“…For example, in two cases of oleander poisoning in adults, comparable digoxin levels of 1.2 [8] and 1.5 ng/ml [9], respectively, in the blood samples were obtained; in these cases the immunoassays used yielded completely different results-mild cardiac symptoms [8] and death [9]. In contrast, well-defined toxicological data were published by Tracqui et al [15], who reported 1.1 ng/ml oleandrin (venous blood) in a non-fatal case that resulted in mild cardiac symptomatology, and by Arao et al [17], who reported 9.8 ng/ml oleandrin (heart blood) in a fatal poisoning.…”

“…These include immunoassays using chemiluminescent (ACS), radio labelling (RIA), and fluorescence polarisation (FPIA) as detection system [5][6][7][8][9], as well as thin layer chromatography (TLC) [10,11] and high-performance liquid chromatography (HPLC) combined with derivatisation and fluorescence detection (FLD) [12,13] and with mass spectrometry (MS) [14][15][16][17], a very sensitive and specific method for the analysis of plant toxins [18,19].…”

Réponses analytiques aux intoxications par substances végétales

“…Il apparaît que la LC/MS et la LC/MS-MS sont des méthodes de choix pour la détermination de toxiques végétaux (7,14). Cette méthode analytique appliquée à l'identification et au dosage des principaux alcaloïdes toxiques causes de décès, est la seule méthode de recherche large actuellement disponible permettant d'atteindre des limites de sensibilité de 1 à 0,1 ng/ml (voire moins).…”

Interferences of Herbal Remedies with Immunoassays for Therapeutic Drugs: Focus on Digoxin

“…Although the digoxin immunoassay with high cross -reactivity against oleandrin such as Digoxin III or Dimension Vista digoxin assay can be used for the indirect detection of apparent digoxin concentration in a suspected oleander poisoning, for a defi nite diagnosis, the presence of oleandrin, the toxic glycoside in oleander in blood, should be confi rmed using highperformance liquid chromatography and mass spectrometry (HPLC/MS), a direct analytical technique for detection of oleandrin in blood [39] .…”