Yellow oleander poisoning in Sri Lanka: outcome in a secondary care hospital

Abstract

<jats:p> Cardiac toxicity after self-poisoning from ingestion of yellow oleander seeds is common in Sri Lanka. We studied all patients with yellow oleander poisoning (YOP) admitted to a secondary care hospital in north central Sri Lanka from May to August 1999, with the objective of determining the outcome of management using currently available treatment. Patients with bradyarrhythmias were treated with intravenous boluses of atropine and intravenous infusions of isoprenaline. Temporary cardiac pacing was done for those not responding to drug therapy. During the study period 168 patients with YOP were admitted to the hospital (male:female=55:113). There were six deaths (2.4%), four had third-degree heart block and two died of undetermined causes. They died soon after delayed admission to the hospital before any definitive treatment could be instituted. Of the remaining 162 patients, 90 (55.6%) patients required treatment, and 80 were treated with only atropine and/or isoprenaline while 10 required cardiac pacing in addition. Twenty-five (14.8%) patients had arrhythmias that were considered life threatening (second-degree heart block type II, third-degree heart block and nodal bradycardia). All patients who were treated made a complete recovery. Only a small proportion of patients (17%) admitted with YOP developed life-threatening cardiac arrhythmias. Treatment with atropine and isoprenaline was safe and adequate in most cases. </jats:p>

Yellow oleander poisoning in eastern province: An analysis of admission and outcome

“…The patients (69%) who have taken less seeds (1-3) had developed more cardiac toxic manifestation than those taken more seeds (6)(7)(8)(9)(10). This may be due to intake of more seeds had effect on forced vomiting by the patients.…”

“…The most common ECG abnormality is bradycardia, which may be sinus bradycardia, sinus arrest or exit block, or AV nodal dissociation (third degree heart block). [7] Careful observation of cardiac rhythm should continue for a minimum of 24 hours. In our study, most of the patients (65%) developed above ECG findings within 24 hours (10-14 h) of ingestion of YOP.…”

“…[7] We use such an atropine bolus followed by an infusion to maintain the pulse above 80 beats/minute. The effect of atropine on outcomes has not been formally assessed, but clinical experience suggests benefit.…”

Extractability of Thevetia peruviana glycosides with alcohol mixture

“…Ingestion of thevetia seed by either man or animal has been reported to result in severe cardiac toxicity which produced marked poisoning symptoms that culminated in death (Oji and Okafor, 2000;de Silva et al, 2003;Fonseka et al, 2002). Symptoms include nausea, vomting and giddiness within hours.…”

Fatal Flower

“…All parts of the plant are considered to be poisonous. A report from Australia found it to be the causative agent for 27% of poisonings in the pediatric age group [3]. The clinical picture on ingestion is similar to digoxin toxicity [4].…”