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Oleander Poisoning

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Plant Toxins

Part of the book series: Toxinology ((TOXI))

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Abstract

In modern times, poisonous plants, notably members of the family Apocynaceae, have been widely used for suicide and rarely for homicide in South Asia. Poisoning from Nerium oleander and Thevetia peruviana is a common toxicological emergency in tropical and subtropical parts of the world. Intentional self-poisoning with seeds from the yellow oleander tree (Thevetia peruviana) is widely reported. There are now tens of thousands of yellow oleander poisoning cases in South Asia each year and probably thousands of deaths. At present, yellow oleander poisoning has a 10% mortality rate in Sri Lanka. In addition the burden imposed on the healthcare system due to emergency life support and subsequent care of patients is considerable.

Many cardenolides have been identified in the oleander that are structurally similar to the digitalis cardenolides derived from the foxglove. Ingestion of its seeds results in a clinical picture similar to digoxin toxicity. It contains cardiac glycosides that are toxic to cardiac myocytes and autonomic system. Cardiac glycosides of oleander cause poisoning by inhibiting plasmalemmal Na+/K+-ATPase. The main clinical features caused by ingestion of Nerium oleander (common oleander) or Thevetia peruviana (yellow oleander) include nausea, vomiting, abdominal pain, diarrhea, dysrhythmias, and hyperkalemia. In most cases, clinical management of poisoning from these plants involves administration of activated charcoal and supportive care. Digoxin-specific Fab antibody fragments are an effective therapeutic agent in managing patients with acute intoxication with serious dysrhythmias or hyperkalemia. However, where limited economic resources restrict the use of such Fab fragments, treatment of severely poisoned patient is difficult. Cardiology consultation is recommended for poisoned patients exhibiting arrhythmias and/or other cardiovascular comorbidities.

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References

  • American Academy of Clinical Toxicology. European Association of Poisons Centres and Clinical Toxicologists, Position paper: ipecac syrup. J Toxicol Clin Toxicol. 2004a;42:133–43.

    Google Scholar 

  • American Academy of Clinical Toxicology (AACT). European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) Position Statement: gastric lavage. J Toxicol Clin Toxicol. 2004b;42:933–43.

    Google Scholar 

  • Ansford AJ, Morris H. Fatal oleander poisoning. Med J Aust. 1981;1:360–1.

    CAS  PubMed  Google Scholar 

  • Aslani MR. Poisonous plants of Iran and their effects on animals. 1st ed. Mashhad: Mashhad University Press; 2004. p. 210–2.

    Google Scholar 

  • Bandara V, Weinstein SA, White J, Eddleston M. A review of natural history, toxinology, diagnosis and clinical management of Nerium oleander (common oleander) and Thevetia peruviana (yellow oleander) poisoning. Toxicon. 2010;56:273–81.

    Article  CAS  PubMed  Google Scholar 

  • Barceloux DG. Medical toxicology of natural substances: foods, fungi, medicinal herbs, plants, and venomous animals. Canada: Wiley; 2008.

    Book  Google Scholar 

  • Bismuth C, Gaultier M, Conso F, Efthymiou ML. Hyperkalaemia in acute digitalis poisoning: prognostic significance and therapeutic implications. Clin Toxicol. 1973;6:153–62.

    Article  CAS  PubMed  Google Scholar 

  • Blum LM, Rieders F. Oleandrin distribution in a fatality from rectal and oral Nerium oleander extract administration. J Anal Toxicol. 1987;11:219–21.

    Article  CAS  PubMed  Google Scholar 

  • Bose TK, Basu RK, Biswas B, De JN, Majumdar BC, Datta S. Cardiovascular effects of yellow oleander ingestion. J Indian Med Assoc. 1999;97:407–10.

    CAS  PubMed  Google Scholar 

  • Brewster D. Herbal poisoning: a case report of a fatal yellow oleander poisoning from the Solomon Islands. Ann Trop Paediatr. 1986;6:289–91.

    Article  CAS  PubMed  Google Scholar 

  • Camphausen C, Haas NA, Mattke AC. Successful treatment of oleander intoxication (cardiac glycosides) with digoxin-specific Fab antibody fragments in a 7-year-old child: case report and review of literature. Z Kardiol. 2005;94:817–23.

    Article  CAS  PubMed  Google Scholar 

  • Dasgupta A, Hart AP. Rapid detection of oleander poisoning using fluorescence polarization immunoassay for digitoxin. Effect of treatment with digoxin-specific Fab antibody fragment (ovine). Am J Clin Pathol. 1997;108:411–6.

    Article  CAS  PubMed  Google Scholar 

  • Dasgupta A, Risin SA, Reyes M, Actor JK. Rapid detection of oleander poisoning using fluorescence polarization immunoassay for digitoxin III, a new digoxin assay: impact on serum Digoxin measurement. Am J Clin Pathol. 2008;129:548–53.

    Article  CAS  PubMed  Google Scholar 

  • Davey M. Calcium for hyperkalaemia in digoxin toxicity. Emerg Med J. 2002;19:183.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • De Silva HA, Fonseka MMD, Pathmeswaran A, et al. Multiple-dose activated charcoal for treatment of yellow oleander poisoning: a single-blind, randomised, placebo-controlled trial. Lancet. 2003;361:1935–8.

    Article  PubMed  Google Scholar 

  • De Silva HA, Pathmeswaran A, Lalloo DG, De Silva HJ, Aronson JA. Multiple-dose activated charcoal in yellow oleander poisoning. Lancet. 2008;371:2171–2.

    Article  PubMed  Google Scholar 

  • Demiryurek AT, Demiryurek S. Cardiotoxicity of digitalis glycosides: roles of autonomic pathways, autacoids and ion channels. Auton Autacoid Pharmacol. 2005;25:35–52.

    Article  CAS  PubMed  Google Scholar 

  • Dorsey CS. Plant dermatitis in California. Calif Med. 1962;96:412–3.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Driggers DA, Solbrig R, Steiner JF, Swedberg J, Jewell GS. Acute oleander poisoning – a suicide attempt in a geriatric patient. West J Med. 1989;51:660–2.

    Google Scholar 

  • Dwivedi S, Rajpal S, Narang S. Cardiotoxic manifestations of yellow oleander (Thevetia nerifolia) poisoning and its treatment: a case report. Indian Heart J. 2006;58:450–1.

    CAS  PubMed  Google Scholar 

  • Eddleston M, Persson H. Acute plant poisoning and antitoxin antibodies. J Toxicol Clin Toxicol. 2003;41:309–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Eddleston M, Warrell A. Management of acute yellow oleander poisoning. Q J Med. 1999;92:483–5.

    Article  CAS  Google Scholar 

  • Eddleston M, Sheriff MHR, Hawton K. Deliberate self-harm in Sri Lanka: an overlooked tragedy in the developing world. BMJ. 1998;317:133–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Eddleston M, Ariaratnam CA, Meyer WP, 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.

    Article  CAS  PubMed  Google Scholar 

  • Eddleston M, Ariaratnam CA, Sjostrom L, Jayalath S, Rajakanthan K, Rajapakse S, Colbert D, Meyer WP, Perera G, Attapattu S, Kularatne SA, Sheriff MR, Warrell DA. Acute yellow oleander (Thevetia peruviana) poisoning: cardiac arrhythmias, electrolyte disturbances, and serum cardiac glycoside concentrations on presentations to hospital. Heart. 2000a;83:301–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Eddleston M, Rajapakse S, Rajakanthan K, Jayalath S, Sjostrom L, Santharaj W, Thenabadu PN, Sheriff MH, Warrell DA. Anti-digoxin Fab fragments in cardiotoxicity induced by ingestion of yellow oleander: a randomised controlled trial. Lancet. 2000b;355:967–72.

    Article  CAS  PubMed  Google Scholar 

  • Eddleston M, Senarathna L, Mohamed F, Buckley N, Juszczak E, Sheriff MH, Ariaratnam A, Rajapakse S, Warrell D, Rajakanthan K. Deaths due to absence of an affordable antitoxin for plant poisoning. Lancet. 2003;362:1041–4.

    Article  PubMed  Google Scholar 

  • Eddleston M, Dissanayake M, Sheriff MHR, Warrell DA, Gunnell D. Physical vulnerability and fatal self-harm in the elderly. Br J Psychiatry. 2006;189:278–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Eddleston M, Haggalla S, Reginald K, Sudarshan K, Senthilkumaran M, Karalliedde L, Ariaratnam A, Sheriff MHR, Warrell DA, Buckley N. The hazards of gastric lavage for intentional self-poisoning in a resource poor location. Clin Toxicol. 2007;45:136–43.

    Article  Google Scholar 

  • Eddleston M, Juszczak E, Buckley NA, Senarathna L, Mohamed F, Dissanayake W, Hittarage A, Azher S, Jeganathan K, Jayamanne S, Sheriff MHR, Warrell DA. Multiple – dose activated charcoal in acute self-poisoning: a randomized controlled trial. Lancet. 2008a;371:579–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Eddleston M, Juszczak E, Buckley NA. Multiple-dose activated charcoal in yellow oleander poisoning. Lancet. 2008b;371:2171–2.

    Article  CAS  Google Scholar 

  • Fonseka MM, Seneviratne SL, de Silva CE, Gunatilake SB, de Silva HJ. Yellow oleander poisoning in Sri Lanka: outcome in a secondary care hospital. Hum Exp Toxicol. 2002;21(6):293–5.

    Article  CAS  PubMed  Google Scholar 

  • Galey FD, Johnson B, Mass M. Analysis and significance of toxins in livestock poisoned by plants. FEDRIP Database, National Technical Information Service (NTIS). 1990.

    Google Scholar 

  • Gaultier M, Fournier E, Efthymiou ML. Intoxication digitaliqueaigue (70 observations). Bull Soc Med Hop Paris. 1968;119:247–74.

    CAS  PubMed  Google Scholar 

  • Haynes BE, Bessen HA, Wightman WD. Oleander tea: herbal draught of death. Ann Emerg Med. 1985;14:350–3.

    Article  CAS  PubMed  Google Scholar 

  • Heard K. Digoxin and therapeutic cardiac glycosides. In: Dart RC, editor. Medical toxicology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2004.

    Google Scholar 

  • Karawya MS, Balbaa SI, Khayyal SE. Estimation of cardenolides in Nerium oleander. Planta Med. 1973;23:70–3.

    Article  CAS  PubMed  Google Scholar 

  • Kelly RA, Smith TW. Recognition and management of digitalis toxicity. Am J Cardiol. 1992;69:108G–19.

    Article  CAS  PubMed  Google Scholar 

  • Kyerematen G, Hagos M, Weeratunga G, Sandbrg F. The cardiac glycosides of Thevetia ovata A.Dc. and Thevetia neriifolia Juss. Ex Stend. Acta Pharm Suec. 1985;22:37–44.

    CAS  PubMed  Google Scholar 

  • Langford SD, Boor PJ. Oleander toxicity: an examination of human and animal toxic exposures. Toxicology. 1996;109(1):1–13.

    Article  CAS  PubMed  Google Scholar 

  • Le Couteur DG, Fisher AA. Chronic and criminal administration of Nerium oleander. J Toxicol. 2002;40:523–4.

    Google Scholar 

  • Lederer WJ, Tsien RW. Transient inward current underlying arrhythmogenic effects of cardiotonic steroids in Purkinje fibres. J Physiol. 1976;263:73–100.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Linden CH. Digitalis glycosides. In: Ford MD, Delaney KA, Ling LJ, Erickson T, editors. Clinical toxicology. Philadelphia: W. B. Saunders; 2001. p. 379–90.

    Google Scholar 

  • Mack RB. ‘To see a world in a grain of sand and a heaven in a wild flower’ – oleander poisoning. NC Med J. 1984;45:729–30.

    CAS  Google Scholar 

  • Mahdyoon H, Battilana G, Rosman H, Goldstein S, Gheorghiade M. The evolving pattern of digoxin intoxication: observations at a large urban hospital from 1980 to 1988. Am Heart J. 1990;120:1189–94.

    Article  CAS  PubMed  Google Scholar 

  • Morton JF. In: Tedeschi CG, Eckert WG, Tedeschi LG, editors. Forensic medicine. A study in trauma and environmental hazards, vol. III. Philadelphia: W. B. Saunders; 1977.

    Google Scholar 

  • O’Leary SB. Poisoning in man from eating poisonous plants. Arch Environ Health. 1964;9:216–42.

    Article  PubMed  Google Scholar 

  • Oji O, Okafor QE. Toxicological studies on stem bark, leaf and seed kernel of yellow oleander (Thevetia peruviana). Phytother Res. 2000;14:133–5.

    Article  CAS  PubMed  Google Scholar 

  • Ooi H, Colucci WS. Pharmacological treatment of heart failure. In: Hardman JG, Limbird LE, Goodman Gilman A, editors. Goodman and Gilman’s the Pharmacological basis of Therapeutics. 10th ed. New York: McGraw – Hill; 2001. p. 901–32.

    Google Scholar 

  • Opie LH. Anti-arrhythmic agents in ischemic heart disease: supraventricular arrhythmias, digitalis toxicity and chronic stable ventricular ectopic beats. Methods Find Exp Clin Pharmacol. 1982;4:25–35.

    CAS  PubMed  Google Scholar 

  • Osterloh J, Herold S, Pond S. Oleander interference in the digoxin radioimmunoassay in a fatal ingestion. JAMA. 1982;247:1596–7.

    Article  CAS  PubMed  Google Scholar 

  • Parikh CK. Parikh textbook of medical jurisprudence and toxicology. 4th ed. Bombay: Medical Publication; 1989. p. 912–4.

    Google Scholar 

  • Pearn J. Oleander poisoning. In: Covacevich J, Davine P, Pearn J, editors. Toxic plants and animals: a guide for Australia. 2nd ed. Brisbane: William Brooks; 1989. p. 37–50.

    Google Scholar 

  • Peiris-John RJ, Wickremasinghe AR. Efficacy of activated charcoal in yellow oleander poisoning. Ceylon Med J. 2008;53:33–5.

    Article  CAS  PubMed  Google Scholar 

  • Pierre Noel AV, Brutus TC. Les Plantes et les Legumes d’ Haiti qui Guerissent; Mille et Une Recetta Pratiques, vol. 2. Impr. Del’Etat, Port –au-Prince; 1959.

    Google Scholar 

  • Radford DJ, Gillies AD, Hinds JA, Duffy P. Naturally occurring cardiac glycosides. Med J Aust. 1986;144:540–4.

    CAS  PubMed  Google Scholar 

  • Rajapakse S. Management of yellow oleander poisoning. Clin Toxicol. 2009;473:206–12.

    Article  Google Scholar 

  • Reissell P, Manninen V. Effect of administration of activated charcoal and fibre on absorption, excretion and steady state blood levels of digoxin and digitoxin. Evidence for intestinal secretion of the glycosides. Acta Med Scand Suppl. 1982;668:88–90.

    CAS  PubMed  Google Scholar 

  • Roberts DM, Southcott E, Potter JM, Roberts MS, Eddleston M, Buckly NA. Pharmacokinetics of digoxin cross-reacting substances in patients with acute yellow oleander (Thevetia peruviana) poisoning, including the effect of activated charcoal. Ther Drug Monit. 2006;28:784–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Safadi R, Levy I, Amitai Y, Caraco Y. Beneficial effects of digoxin-specific Fab antibody fragments in oleander intoxication. Arch Intern Med. 1995;155:2121–5.

    Article  CAS  PubMed  Google Scholar 

  • Saravanapavananthan T. Plant poisoning in Sri Lanka. Jaffna Med J. 1985;20:17–21.

    Google Scholar 

  • Saravanapavananthan N, Ganeshamoorthy J. Yellow oleander poisoning – a study of 170 cases. Forensic Sci Int. 1988;36:247–50.

    Article  CAS  PubMed  Google Scholar 

  • Schvartsman S, editor. Plantas venenosas e animais peconhentos. 2nd ed. Sao Paulo: Sarvier; 1992.

    Google Scholar 

  • Shawn D, Pearn J. Oleander poisoning. Med J Aust. 1979;2:267–9.

    Google Scholar 

  • Sheperd RCH. Pretty but poisonous, plants poisonous to people, an illustrated guide for Australia. Australia: R.G. and F.J Richardson; 2004.

    Google Scholar 

  • Shumaik GM, Wu AW, Ping AC. Oleander poisoning: treatment with digoxin-specific Fab antibody fragments. Ann Emerg Med. 1988;17:732–5.

    Article  CAS  PubMed  Google Scholar 

  • Thilagar S, Thirumalaikolundusubramanian P, Gopalakrishnan S, Lakshmikandan R, Ayyappan A, Subramanian R. Possible yellow oleander toxicity in a neonate. Indian Pediatr. 1986;23:393.

    CAS  PubMed  Google Scholar 

  • WasfiI A, Zorob O, Al katheeri NA, Al Awadhi AM. A fatal case of oleandrin poisoning. Forensic Sci Int. 2008;179:31–6.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

    Christeine Ariaranee Gnanathasan

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  1. Christeine Ariaranee Gnanathasan
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Correspondence to Christeine Ariaranee Gnanathasan .

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Editors and Affiliations

  1. Instituto do Cérebro, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil

    Célia Regina Carlini

  2. Centro de Biotecnologia, Universidade Federal do Rio Grande do Su, Porto Alegre, RS, Brazil

    Rodrigo Ligabue-Braun

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Gnanathasan, C.A. (2017). Oleander Poisoning. In: Carlini, C., Ligabue-Braun, R. (eds) Plant Toxins. Toxinology. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-6464-4_22

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