2. Case
β’ 18 yr old unmarried pregnant Tamilian female brought
to the casualty with giddiness and vomiting
β’ PR β 38/mt irregular BP β 90/60mmHg
β’ No focal deficits
β’ Toxic look
β’ CVS- S1 varying S2 with normal split
β’ Chest β NVBS
β’ Alleged consumption of Nerium Seeds from work site
7. Patient stay in hospital was uneventful and
treated with orciprenaline , electrolyte
correction & antibiotic.
Patient removed from temporary pacing
β’ Discharged on the 8th day.
10. β’ Dogbane family
β’ Ornamental shrub with white & pink flowers
β’ All parts are poisonous including the smoke
while burning
β’ Used as an abortifacient, homicide and suicide
β’ Fatal dose β 15-20 gms of root
β’ Fatal period β 24 to 36 hrs
14. β’ Fatal dose β kernel of one fruit
β’ Fatal period -1-2 days
15. Aconite (mitha zeher- monk`s hood)
β’ All parts are poisonous especially the root
β’ Clinical features- nausea , vomiting , profuse
sweating
β’ Hippus
β’ Hypotension, AV BLOCK
β’ Fatal dose β 1gm of root
β’ Fatal period β 1-8 hrs
β’ Treatment βGastric lavage , atropine
16. Cleistanthus collinus (oduvan)
β’ Closely related- it is a glucoside
β’ Blocks cardiac conductive system
β’ Conduction defects
β’ Fatal dose β 200-400gms of leaves
β’ Fatal period β 1-3 days
17. POPULARITY AS A POISON
β’ In Sri Lanka, cases of attempted suicide with
yellow oleander were extremely rare before
1980.
During that year, the deaths of two girls who
intentionally ate yellow oleander seeds was
widely reported in local newspapers.
The practice suddenly became so popular that
the number of cases admitted to Jaffna
hospital increased from zero in 1979 to 103 in
1983.
QJM (1999) 92 (9): 483-485. doi: 10.1093/qjmed/92.9.483
18. Studies across the world
β’ Dept of internal medicine, Colombo- a study on 300
patients -Ventricular ectopics and tachycardias are
common in digoxin-poisoned patients, but are less
common in oleander-poisoned patients
β’ 53% had AV node conduction block, while 62% had
sinus node block; 30% had conduction block affecting
both nodes. Only 1% had ventricular tachycardias and
8% had ventricular ectopics
β’ They report that most of the deaths are due to
ventricular arrhythmia
β’ Mortality is 20% in their study.
20. Management
β’ Induction of emesis & activated charcoal
Administering Atropine for severe bradycardia
Using Phenytoin or Lidocaine hydrochloride to
control arrhythmia.
Placing a temporary venous pacemaker
Electrical counter shock
Digoxin-specific Fab antibody fragments
(Digibind).
21. β’ Osterloh et al calculated the lethal oleander
leaf dose of their patient to be approximately
4 gm.