Yellow Oleander Toxicity

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Yellow Oleander Toxicity

• Robi Goswami
• Duke University Internal Medicine
• Global Health Rotation Sri Lanka

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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)

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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

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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

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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

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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.

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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 15521215
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