1. Yellow Oleander Toxicity
Robi Goswami
Duke University Internal Medicine
Global Health Rotation – Sri Lanka

2. Yellow oleander (Thevetia peruviana)
Indigenous plant in many tropical areas, including throughout Sri Lanka
All parts of the plant are poisonous, especially seeds
Contain several cardiac glycosides (same family as digitalis)

3. Yellow Oleander Abuse in Sri Lanka
Suicide rates are very high in Sri Lanka
Self-ingestion of yellow oleander seeds is becoming an increasingly common method of suicide in Sri Lanka, rarely seen elsewhere in the world
Treatment of overdose is difficult in resource-poor countries like Sri Lanka resulting in high morbidity and mortality

4. Symptoms of Toxicity Can be associated with burning in the mouth
Nausea/vomiting can occur within 6-12 hours after ingestion
Some patients report yellow vision changes or anxiety

5. Effects of Yellow Oleander
Hyperkalemia
Convulsion
Numerous cardiac effects:
Significant ventricular ectopy, ultimately leading to VT or VF if severe
High-degree AV block
Accelerated junctional rhythms
Sinoatrial blocks
Coma

6. Treatment of Oleander Toxicity
Some evidence for use of Digibind in oleander poisoning
In Sri Lanka high cost precludes use of this drug
Temporary pacemakers until drug is metabolized if AV block is evident
Resource limitations require careful patient selection for use of temporary pacers in Sri Lanka
General supportive care including atropine, diazepam for convulsions, vasopressors, electrolyte monitoring, respiratory support, etc.

7. References
“Management of acute yellow oleander poisoning.” Eddleston, M and Warrell, DA. Q J Med 1999; 92:
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