Management of Oleander (Odollum) Poisoning
Administer digoxin-specific antibody fragments (Digoxin immune Fab) at a dose of 1200 mg (30 vials) for yellow oleander poisoning, as this is the definitive antidote for cardiac glycoside toxicity from this plant. 1
Immediate Priorities
- Contact your regional poison control center immediately for specialized toxicological consultation, as oleander poisoning requires expert guidance 2
- Secure airway, breathing, and circulation first—this takes absolute priority over antidote administration or toxin identification 3, 2
- Establish hemodynamic monitoring and support to maintain cardiovascular stability 2
- Correct critical vital sign abnormalities and metabolic derangements immediately 2
Cardiac Glycoside-Specific Treatment
Digoxin immune Fab is the specific antidote for oleander poisoning because oleander contains cardiac glycosides (oleandrin) that bind to the same receptors as digoxin 1:
- Adult dose: 1200 mg (30 vials) IV for yellow oleander poisoning 1
- Pediatric dose: Unknown (consult poison control) 1
- Each vial contains 40 mg Fab 1
- Lower doses may be equally effective in some cases 1
Supportive Cardiac Management
If Fab is unavailable or while awaiting administration:
- Atropine 0.5-1.0 mg IV every 3-5 min (up to 3 mg) for bradycardia or heart block 1
- Pediatric atropine: 0.02 mg/kg 1
- Avoid calcium administration—it can worsen cardiac glycoside toxicity (unlike other poisonings where calcium is beneficial) 1
Decontamination
- Remove all contaminated clothing and wash exposed skin thoroughly with soap and water 2
- Healthcare providers must use personal protective equipment to prevent secondary contamination 2
- Do NOT induce vomiting—this may worsen cardiovascular instability 2
- Activated charcoal may be considered if advised by poison control and patient can protect airway, preferably within 2 hours of ingestion 4, 5
Neurological Management
- Administer benzodiazepines (diazepam or midazolam) for seizures or severe agitation if they occur 2
- Avoid neuromuscular blockers without adequate sedation—they mask seizure activity without treating it 2
Monitoring Requirements
- Continuous cardiac monitoring is essential due to risk of life-threatening dysrhythmias (bradycardia, heart block, ventricular tachycardia, ventricular fibrillation) 6
- Monitor serum potassium closely—cardiac glycosides cause hyperkalemia by inhibiting Na-K-ATPase 1
- Observe for at least 48-72 hours even in apparently stable patients due to risk of delayed cardiac effects 2
Critical Pitfalls to Avoid
- Do NOT delay Fab administration while waiting for confirmatory testing—treat based on clinical presentation and exposure history 2
- Do NOT give calcium—it potentiates cardiac glycoside toxicity and can precipitate fatal dysrhythmias 1
- Do NOT assume stability means safety—cardiac toxicity can be delayed and sudden 2
- Seek expert toxicology consultation early—oleander poisoning requires specialized management that most clinicians encounter infrequently 2, 6
- Consider prolonged CPR and extraordinary measures (including ECMO) if cardiac arrest occurs, as these patients may benefit from resuscitation beyond standard ACLS timelines while antidote takes effect 6