Plant: Nerium oleander
The toxins are cardiac glycosides and include:
(1) oleandrin
(2) neriine
(3) oleandroside
(4) nerioside
(5) digitoxigenin
Methods of exposure:
(1) accidental or intentional (suicidal) ingestion of leaves, flowers or pods
(2) using an oleander branch to skewer and cook meat
(3) eating meat cooked over burning oleander branches
(4) stirring a drink with an oleander stem
(5) ingestion of tea made from oleander leaves
Clinical findings:
(1) nausea and vomiting
(2) cardiac arrhythmias (bradyarrhythmias, tachyarrhythmias, heart block, ectopic rhythms) which may last several days
(3) cardiac arrest
Laboratory testing:
(1) hyperkalemia
(2) elevated serum digoxin concentration.
Treatment consists of
(1) gut decontamination
(2) reversal of the hyperkalemia
(3) infusion of anti-digoxin Fab fragments
(4) control of the cardiac arrhythmias
(5) insertion of a temporary pacemaker if significant heart block develops
