From the Guidelines
Nerium oleander seed poisoning is a life-threatening condition that requires immediate medical attention, and treatment with digoxin-specific antibody fragments (digoxin-Fab) is recommended in severe cases, as supported by the 2023 American Heart Association guidelines 1.
Key Considerations
- Oleander seeds contain cardiac glycosides similar to digoxin, which can cause severe heart rhythm disturbances, gastrointestinal symptoms, and neurological effects.
- Symptoms can occur within hours of ingestion and may include nausea, vomiting, dizziness, and irregular heartbeat.
- All parts of the plant are toxic, with seeds being particularly concentrated.
Treatment Approach
- If ingestion is suspected, call emergency services or go to the nearest emergency room immediately.
- Do not induce vomiting unless directed by medical professionals.
- Bring a sample of the plant or seeds if possible for identification.
- Treatment typically involves:
- Activated charcoal to prevent further absorption
- IV fluids for hydration and electrolyte management
- Cardiac monitoring and possible antiarrhythmic medications
- Atropine for severe bradycardia
- Digoxin-specific antibody fragments in severe cases, as recommended by the American Heart Association guidelines 1.
Prevention and Education
- Prevention is crucial: educate about the plant's toxicity, keep oleander out of reach of children and pets, and never use it for medicinal purposes.
- Prompt medical attention is essential for the best outcome in cases of poisoning, as highlighted in the 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning 1.
From the Research
Effects of Nerium oleander seed poisoning
- The seeds of Nerium oleander are highly poisonous and contain toxic cardiac glycosides, which can cause significant morbidity and mortality 2.
- Ingestion of yellow oleander seeds can lead to various cardiovascular effects, including rhythm abnormalities, such as bradycardia, sinus bradycardia, and ischemic changes 3, 4.
- The clinical manifestations of yellow oleander poisoning can range from mild to potentially fatal, with symptoms including vomiting, abdominal pain, diarrhea, and cardiac dysrhythmias 4.
- Cardiac toxicity can develop within 24 hours of ingestion, and the risk of toxicity has a negative correlation with the number of seeds ingested 4.
Treatment and Management
- Treatment of yellow oleander poisoning typically involves supportive care, including correction of dehydration, antiemetics, and electrolyte management 2.
- Gastric decontamination using activated charcoal may be beneficial, although the effectiveness of multiple doses is still debated 2.
- Arrhythmia management may involve the use of atropine, isoprenaline, and temporary cardiac pacing, although further studies are needed to determine the best approach 2.
- Digoxin-specific antibody fragments have been shown to be effective in reverting life-threatening cardiac arrhythmias, but their high cost and limited availability limit their use in developing countries 2, 5.
- Fructose-1,6-diphosphate (FDP) has been investigated as a potential novel antidote for yellow oleander-induced cardiac toxicity, with promising results in a randomized controlled trial 6.