Heart 2000;83:301-306 ( March )

Cardiovascular medicine

Acute yellow oleander (Thevetia peruviana) poisoning: cardiac arrhythmias, electrolyte disturbances, and serum cardiac glycoside concentrations on presentation to hospital M Eddleston^a, C A Ariaratnam^b, L Sjöström^c, S Jayalath^b, K Rajakanthan^b, S Rajapakse^b, D Colbert^d, W P Meyer^c, G Perera^a, S Attapattu^e, S A M Kularatne^e, M R Sheriff^b, D A Warrell^a

^a Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Headington, Oxford OX3 9DU, UK, ^b Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, ^c Therapeutic Antibodies Inc, Medical College of St Bartholomew's Hospital, London EC1, UK, ^d Department of Chemical Pathology, Homerton Hospital, London E9, UK, ^e Anuradhapura General Hospital, Anuradhapura, Sri Lanka

Correspondence to: Professor Warrell. email: david.warrell{at}ndm.ox.ac.uk

Accepted 23 September 1999

OBJECTIVETo describe the cardiac arrhythmias, electrolyte disturbances, and serum cardiac glycoside levels seen in patients presenting to hospital with acute yellow oleander (Thevetia peruviana) poisoning and to compare these with published reports of digitalis poisoning.
DESIGNCase series.
SETTINGMedical wards of Anuradhapura District General Hospital, Sri Lanka, and coronary care unit of the Institute of Cardiology, National Hospital of Sri Lanka, Colombo, the national tertiary referral centre for cardiology.
PATIENTS351 patients with a history of oleander ingestion.
MEASUREMENTSECG and blood sample analysis on admission.
RESULTSMost symptomatic patients had conduction defects affecting the sinus node, the atrioventricular (AV) node, or both. Patients showing cardiac arrhythmias that required transfer for specialised management had significantly higher mean serum cardiac glycoside and potassium but not magnesium concentrations. Although there was considerable overlap between groups, those with conduction defects affecting both sinus and AV nodes had significantly higher mean serum cardiac glycoside levels.
CONCLUSIONSMost of these young previously healthy patients had conduction defects affecting the sinus or AV nodes. Relatively few had the atrial or ventricular tachyarrhythmias or ventricular ectopic beats that are typical of digoxin poisoning. Serious yellow oleander induced arrhythmias were associated with higher serum cardiac glycoside concentrations and hyperkalaemia but not with disturbances of magnesium.


Keywords: oleander poisoning; arrhythmias; cardiac glycosides

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© 2000 by Heart
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