A case series of oleander poisoning: challenges faced by emergency physicians in developing countries

Utsav Anand Mani; Mukesh Kumar; Haider Abbas; Pranay Gupta

doi:10.18502/fem.v6i4.10431

Utsav Anand Mani Department of Emergency Medicine, King George’s Medical University, Lucknow, India.
Mukesh Kumar Department of Emergency Medicine, King George’s Medical University, Lucknow, India.
Haider Abbas Department of Emergency Medicine, King George’s Medical University, Lucknow, India.
Pranay Gupta Department of Emergency Medicine, King George’s Medical University, Lucknow, India.

DOI: https://doi.org/10.18502/fem.v6i4.10431

Keywords: Antibodies; Digoxin; Thevetia; Nerium; Poisoning; Self-Injurious Behavior; Suicide

Abstract

Objective: Through the reporting of this case series, we aim to establish whether a conservative approach, through managing arrhythmias and vital signs, can be reliably used as a treatment modality for oleander poisoning in developing countries.

Methods: This study is a case series of 11 patients who presented with oleander poisoning and were conservatively managed in the absence of standard antidote.

Results: All 11 patients treated with conservative approach survived. Conservative approach included use of atropine for management of symptomatic bradycardia followed by Dopamine infusion, correction of serum potassium and magnesium levels, standby defibrillation, and transvenous pacing.

Conclusion: The absence of reliable dosage of poison ingested, the lack of facilities for serum digoxin estimation, and the unavailability of digoxin fab antibodies pose challenges for the management of patients with oleander poisoning. Patients can, however, be managed conservatively following the Advanced Cardiac Life Support (ACLS) algorithm in a setting that lacks the standard treatment of this poison.