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Anti-digoxin Fab fragments in cardiotoxicity induced by ingestion of yellow oleander: a randomised controlled trial

M Eddleston1, S Rajapakse, Rajakanthan

  • 1Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK.

Lancet (London, England)
|April 18, 2000
PubMed
Abstract

Insights

Anti-digoxin Fab fragments effectively treat yellow oleander-induced cardiac arrhythmias, improving heart rhythm and rate. This treatment offers a safe alternative to patient transfer, potentially reducing mortality in rural Sri Lanka.

Area of Science:

  • Toxicology
  • Cardiology
  • Pharmacology

Background:

  • Yellow oleander seed ingestion causes severe cardiotoxicity in Sri Lanka.
  • Current management requires patient transfer for temporary cardiac pacing.
  • A randomized controlled trial investigated anti-digoxin Fab for oleander-induced arrhythmias.

Purpose of the Study:

  • To evaluate the efficacy of anti-digoxin Fab in reversing serious cardiac arrhythmias caused by yellow oleander ingestion.
  • To assess the safety and effectiveness of anti-digoxin Fab as a treatment in rural healthcare settings.

Main Methods:

  • A randomized controlled trial involving 66 patients with serious cardiac arrhythmias.
  • Patients received either 1200 mg of anti-digoxin Fab or a saline placebo.
  • Electrocardiograms and blood samples were collected to monitor cardiac rhythm, electrolytes, and glycoside levels.

Main Results:

  • Anti-digoxin Fab significantly resolved arrhythmias faster than placebo (p<0.001).
  • A higher proportion of antibody-treated patients achieved sinus rhythm within 8 hours (p<0.001).
  • Treatment with anti-digoxin Fab led to increased heart rate and decreased serum potassium levels.

Conclusions:

  • Anti-digoxin Fab fragments are a safe and effective treatment for yellow oleander-induced cardiac arrhythmias.
  • This intervention can potentially reduce patient transfers and mortality in rural Sri Lankan hospitals.
  • Further studies are needed to confirm the reduction in mortality rates.

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