What is the treatment for Nerium oleander (oleander) fruit poisoning?

From the Guidelines

Treatment for oleander fruit poisoning requires immediate administration of digoxin-specific antibody fragments (Digibind) for severe cases, as recommended by the 2023 American Heart Association guidelines 1.

Key Considerations

• Oleander poisoning is a medical emergency that can cause life-threatening arrhythmias due to its cardiac glycoside content, similar to digoxin.
• The most recent guidelines from 2023 suggest the use of digoxin-specific antibody fragments (Digibind) for severe cases of oleander poisoning 1.
• Treatment should also include supportive care, such as activated charcoal, intravenous fluids, and cardiac monitoring, to manage symptoms and prevent further complications.

Management Approach

• If oleander poisoning is suspected, call poison control (1-800-222-1222) or go to the emergency room immediately.
• Do not induce vomiting unless specifically instructed by medical professionals.
• At the hospital, treatment may involve:
  • Activated charcoal to prevent further absorption of the toxin.
  • Intravenous fluids to maintain hydration and blood pressure.
  • Cardiac monitoring to detect and manage heart rhythm abnormalities.
  • Digoxin-specific antibody fragments (Digibind) for severe cases affecting heart function, with a recommended dose of 10-20 vials for critically ill patients or those with unknown ingested dose 1.

Important Notes

• Recovery depends on the amount ingested and how quickly treatment is received, with close monitoring typically required for at least 24 hours.
• Oleander contains cardiac glycosides that disrupt the heart's electrical system, leading to potentially fatal heart rhythm disturbances.
• The use of digoxin-specific antibody fragments (Digibind) is recommended for severe cases of oleander poisoning, as it can help neutralize the toxic effects of the cardiac glycosides 1.

From the Research

Treatment for Nerium oleander (Oleander) Fruit Poisoning

The treatment for Nerium oleander (oleander) fruit poisoning typically involves a combination of supportive care, correction of arrhythmias and electrolyte imbalance, and administration of specific antidotes.

• The use of multiple-dose activated charcoal has been shown to be effective in reducing deaths and life-threatening cardiac arrhythmias after yellow oleander poisoning 2.
• Atropine and isoprenaline may be used to treat bradycardia and other cardiac arrhythmias 3, 4.
• Digoxin-specific Fab antibody fragments have been used as an antidote in cases of oleander poisoning, and have been shown to be effective in reversing cardiac toxicity 4, 5.
• In some cases, temporary cardiac pacing may be necessary to manage life-threatening cardiac arrhythmias 3.
• Gastroscopy for mechanical removal of a phytobezoar responsible for persistent toxin release should be considered in cases of oleander intoxication 5.
• Conservative treatment, including supportive care and monitoring, may also be effective in some cases of oleander poisoning 6.

Key Considerations

• Oleander poisoning can cause severe cardiac toxicity and should be considered a medical emergency.
• The risk of toxicity has a negative correlation with the number of seeds ingested 3.
• Patients with oleander poisoning may present with nonspecific symptoms, including vomiting, abdominal pain, and diarrhea 3.
• AV conduction defects are common in patients with oleander poisoning 3.
• The dosage of digoxin-specific antibodies should be guided by the clinical severity of the poisoning, rather than plasma levels 5.