Yellow Oleander ToxicityYellow Oleander Toxicity

Robi GoswamiRobi Goswami

Duke University Internal MedicineDuke University Internal Medicine

Global Health Rotation – Sri LankaGlobal Health Rotation – Sri Lanka

Yellow oleander (Yellow oleander (Thevetia peruvianaThevetia peruviana))

Indigenous plant in many Indigenous plant in many tropical areas, including tropical areas, including throughout Sri Lankathroughout Sri LankaAll parts of the plant are All parts of the plant are poisonous, especially poisonous, especially seedsseedsContain several cardiac Contain several cardiac glycosides (same family as glycosides (same family as digitalis)digitalis)

Yellow Oleander Abuse in Sri LankaYellow Oleander Abuse in Sri Lanka

Suicide rates are very high in Sri LankaSuicide rates are very high in Sri Lanka

Self-ingestion of yellow oleander seeds is Self-ingestion of yellow oleander seeds is becoming an increasingly common becoming an increasingly common method of suicide in Sri Lanka, rarely seen method of suicide in Sri Lanka, rarely seen elsewhere in the worldelsewhere in the world

Treatment of overdose is difficult in Treatment of overdose is difficult in resource-poor countries like Sri Lanka resource-poor countries like Sri Lanka resulting in high morbidity and mortalityresulting in high morbidity and mortality

Symptoms of ToxicitySymptoms of Toxicity

Can be associated with burning in the Can be associated with burning in the mouthmouth

Nausea/vomiting can occur within 6-12 Nausea/vomiting can occur within 6-12 hours after ingestionhours after ingestion

Some patients report yellow vision Some patients report yellow vision changes or anxietychanges or anxiety

Effects of Yellow OleanderEffects of Yellow Oleander

HyperkalemiaHyperkalemiaConvulsionConvulsionNumerous cardiac effects:Numerous cardiac effects:– Significant ventricular ectopy, ultimately Significant ventricular ectopy, ultimately

leading to VT or VF if severeleading to VT or VF if severe– High-degree AV blockHigh-degree AV block– Accelerated junctional rhythmsAccelerated junctional rhythms– Sinoatrial blocksSinoatrial blocks

ComaComa

Treatment of Oleander ToxicityTreatment of Oleander Toxicity

Some evidence for use of Digibind in oleander Some evidence for use of Digibind in oleander poisoningpoisoning– In Sri Lanka high cost precludes use of this drugIn Sri Lanka high cost precludes use of this drug

Temporary pacemakers until drug is metabolized Temporary pacemakers until drug is metabolized if AV block is evidentif AV block is evident– Resource limitations require careful patient selection Resource limitations require careful patient selection

for use of temporary pacers in Sri Lankafor use of temporary pacers in Sri Lanka

General supportive care including atropine, General supportive care including atropine, diazepam for convulsions, vasopressors, diazepam for convulsions, vasopressors, electrolyte monitoring, respiratory support, etc.electrolyte monitoring, respiratory support, etc.

ReferencesReferences

““Management of acute yellow oleander poisoning.” Management of acute yellow oleander poisoning.” Eddleston, M and Warrell, DA. Eddleston, M and Warrell, DA. Q J MedQ J Med 1999; 92: 483- 1999; 92: 483-485485

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

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