Cardiovascular effects of yellow oleander ingestion

Yellow oleander (Thevetia neriifolia) is a commonly grown tree found widely in Eastern India. The seeds of yellow oleander are highly poisonous and contain three glycosides--thevetin, thevetoxin and peruvoside. Yellow oleander seed ingestion is usually with suicidal intent in Eastern India. Manifestations range from mild to potentially fatal. It has significant cardiovascular effects with varying rhythm abnormalities. Effects of yellow oleander seed ingestion (YOI) were studied in 300 patients from 1986 to 1990 at BS Medical College, Bankura. Majority i.e., 246 (82%) were females and 226 (75.33%) were young in the age group 11-20 years. Most reported for treatment 6 to 8 hours after ingestion of seeds. The number of seeds swallowed varied from half to fifteen. Two hundred and ninety-two (97.33%) ingested seeds in the crushed form; 156 (52%) were asymptomatic, 92 (30.66%) had vomiting and 36 (12%) had palpitation. In electrocardiogram (ECG), 138 (46%) revealed varying types of arrhythmias including sinus bradycardia in 68 cases (49.27%). Ischaemic changes were present in 118 cases (39.33%). Number of seeds ingested did not bear any relationship with ECG changes in YOI. All 14 cases of death were autopsied. Subendocardial and perivascular haemorrhage with focal myocardial oedema was present in all. Median hospital stay was 5 days (range 2 to 24). During discharge, 256 (85.33%) had normal ECG, 14 (4.66%) had sinus bradycardia and 16 (5.33%) demonstrated ischaemic changes.