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Oleander poisoning: treatment with digoxin-specific Fab antibody fragments
G M Shumaik1, A W Wu, A C Ping
1Regional Poison Center, University of California, San Diego Medical Center 92103-1990.
Abstract:
A 37-year-old man presented two hours after the ingestion of "a handful" of oleander leaves (probably Nerium oleander) in a suicide attempt. Cardiotoxicity was evidenced by the presence of bradycardia (rate, 30 to 45) with sinoatrial nodal arrest and junctional escape consistent with a cardiac glycoside effect. The patient was treated empirically with a single dose of five vials (200 mg) of digoxin-specific Fab antibody fragments (Digibind). The pretreatment digoxin level was 1.5 ng/mL. After treatment, the patient's rhythm stabilized with residual sinus bradycardia (rate, 56). The patient recovered uneventfully and was discharged on the fifth hospital day to inpatient psychiatric care.
Insights
Oleander (Nerium oleander) ingestion caused severe cardiotoxicity, including bradycardia. Treatment with digoxin-specific antibody fragments (Digibind) effectively stabilized the patient's cardiac rhythm, leading to a full recovery.
Area of Science:
- Toxicology
- Cardiology
- Emergency Medicine
Background:
- Oleander (Nerium oleander) contains cardiac glycosides, posing a significant risk of cardiotoxicity upon ingestion.
- Cardiac glycoside poisoning can manifest as severe bradycardia and conduction abnormalities.
Observation:
- A 37-year-old male presented with severe bradycardia and sinoatrial nodal arrest after ingesting oleander leaves.
- The patient's condition was consistent with cardiac glycoside toxicity.
Findings:
- Empirical treatment with digoxin-specific Fab antibody fragments (Digibind) was administered.
- Following Digibind administration, the patient's cardiac rhythm stabilized, showing improvement from severe bradycardia.
Implications:
- Digibind is an effective antidote for oleander-induced cardiotoxicity.
- Prompt recognition and management of oleander poisoning are crucial for patient survival and recovery.