Synonyms: suicide tree, Pong-Pong, Othalanga, Buta-Buta, Nyan
Distribution: Madagascar, south India, Sri Lanka, Vietnam, Cambodia, Myanmar, Malaysia
Toxins: cerberin, 17-alpha and 17-beta neriifolin
Activity: glycosides
The kernel of the fruit is high in toxins. Half to a whole kernel is fatal in humans.
Human toxicity:
(1) bradycardia and other ECG changes mimicking digitalis poisoning (sinus pauses, first/second/complete heart block, ectopic beats)
(2) nausea and vomiting
(3) hyperkalemia
(4) thrombocytopenia
Management:
(1) atropine to reverse bradycardia
(2) cardiac pacemaker for high grade AV nodal block
(3) digoxin immune Fab (in severe cases, if available)
(4) treatment of hyperkalemia
