Citation

Nordt SP, Hendrickson M, Won K, Miller MJ, Swadron SP, Cantrell FL. Am. J. Emerg. Med. 2020; ePub(ePub): ePub.

Affiliation

California Poison Control System, San Diego Division, San Diego, CA, United States of America.

Copyright

(Copyright © 2020, Elsevier Publishing)

DOI

10.1016/j.ajem.2020.04.063

PMID

32387148

Abstract

Cerbera odollam or "pong-pong" tree contains cardiac glycosides similar to digoxin, oleander and yellow oleander. Cerbera odollam is a common method of suicide in South East Asia and has also been used as a weight loss supplement. We present a case of a 33-year-old female presenting with lethargy, vomiting, bradycardia, severe hyperkalemia of 8.9 mEq/L, slow atrial fibrillation followed by cardiovascular collapse following the ingestion of "pong-pong", the kernel of Cerbera odollam, as a weight loss supplement. Despite the administration of a total of nine vials of digoxin-specific Fab the patient could not be resuscitated. Clinicians should be aware of natural cardiac glycosides being uses as weight-loss agents and consider acute cardiac glycoside poisoning in patients with hyperkalemia, abnormal cardiovascular signs, symptoms and abnormal ECG findings.

Copyright © 2020 Elsevier Inc. All rights reserved.

Language: en

Keywords

Cardiac glycoside; Cerbera odollam; Poisoning; Pong-pong; Weight loss