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

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)

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

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

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

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.

References “Management of acute yellow oleander poisoning.” Eddleston, M and Warrell, DA. Q J Med 1999; 92: 483-485 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 www.uptodate.com