A case series of oleander poisoning: challenges faced by emergency physicians in developing countries
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Abstract
Objective: Through the reporting of this case series, we aim to establish whether a conservative approach, through managing arrhythmias and vital signs, can be reliably used as a treatment modality for oleander poisoning in developing countries. Methods: This study is a case series of 11 patients who presented with oleander poisoning and were conservatively managed in the absence of standard antidote. Results: All 11 patients treated with conservative approach survived. Conservative approach included use of atropine for management of symptomatic bradycardia followed by Dopamine infusion, correction of serum potassium and magnesium levels, standby defibrillation, and transvenous pacing. Conclusion: The absence of reliable dosage of poison ingested, the lack of facilities for serum digoxin estimation, and the unavailability of digoxin fab antibodies pose challenges for the management of patients with oleander poisoning. Patients can, however, be managed conservatively following the Advanced Cardiac Life Support (ACLS) algorithm in a setting that lacks the standard treatment of this poison.
2. Pandit V, Kadhiravan T, KNJ PR. Cardiac arrhythmias, electrolyte abnormalities and serum cardiac glycoside concentrations in yellow oleander (Cascabela thevetia) poisoning-a prospective study. Clin Toxicol. 2018;57(2):104-11.
3. Kanji S, MacLean RD. Cardiac glycoside toxicity: more than 200 years and counting. Crit Care Clin. 2012;28(4):527-35.
4. Karthik G, Iyadurai R, Ralph R, Prakash V, Abhilash KP, Sathyendra S, et al. Acute oleander poisoning: A study of clinical profile from a tertiary care center in South India. Fam Med Prim Care Rev. 2020;9(1):136-40.
5. Eddleston M, Ariaratnam CA, Meyer W, Perera G, Kularatne A, Attapattu S, et al. Epidemic of self‐poisoning with seeds of the yellow oleander tree (Thevetia peruviana) in northern Sri Lanka. Trop Med Int Health. 1999;4(4):266-73.
6. Bose T, Basu R, Biswas B, De J, Majumdar B, Datta S. Cardiovascular effects of yellow oleander ingestion. J Indian Med Assoc. 1999;97(10):407-10.
7. Saravanapavananthan N, Ganeshamoorthy J. Yellow oleander poisoning—a study of 170 cases. Forensic Sci Int. 1988;36(3-4):247-50.
8. Anandhi D, Pandit VR, Kadhiravan T, Soundaravally R, Raju KP. Cardiac arrhythmias, electrolyte abnormalities and serum cardiac glycoside concentrations in yellow oleander (Cascabela thevetia) poisoning–a prospective study. Clin Toxicol. 2019;57(2):104-11.
9. Eddleston M, Sheriff MR, Hawton K. Deliberate self harm in Sri Lanka: an overlooked tragedy in the developing world. BMJ. 1998;317(7151):133-5.
10. Prasad A, Krishnaveni K, Neha K, Neethu T, Shanmugasundaram R, Sambathkumar R. A review on management of common oleander and yellow oleander poisoning. World J Pharm Pharm Sci. 2016;5(12):493-503.
11. Zamani J, Aslani A. Cardiac findings in acute yellow oleander poisoning. J Cardiovasc Dis Res. 2010;1(1):27-9.
12. Pirasath S, Arulnithy K. Yellow oleander poisoning in eastern province: An analysis of admission and outcome. Indian J Med Sci. 2013;67(7-8):178-83.
13. Eddleston M, Rajapakse S, Jayalath S, Sjöström L, Santharaj W, Thenabadu P, et al. Anti-digoxin Fab fragments in cardiotoxicity induced by ingestion of yellow oleander: a randomised controlled trial. Lancet. 2000;355(9208):967-72.
14. Mandal L. Yellow oleander-Thevetia peruviana-poisoning. Postgrad Med J NAMS. 2012;12(2):52-5.
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| Issue | Vol 6 No 4 (2022): Autumn (October) | |
| Section | Original article | |
| DOI | 10.18502/fem.v6i4.10431 | |
| Keywords | ||
| Antibodies Digoxin Thevetia Nerium Poisoning Self-Injurious Behavior Suicide | ||
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