Citation

Kovačević T, Polić B, Ardalić T, Petrović D, Stricević L, Rogulj M, Markić J. Arh. Hig. Rada Toksikol. 2023; 74(4): 292-295.

Copyright

(Copyright © 2023, Croatian Institute for Medical Research and Occupational Health)

DOI

10.2478/aiht-2023-74-3752

PMID

38146758

Abstract

Natural cardiac glycosides have positive inotropic heart effects but at high, toxic doses they can cause life-threatening cardiac arrhythmias. Here we present the first Croatian case of a 16-year-old girl who attempted suicide by eating dried oleander leaves, which contain natural cardiac glycosides, and her treatment with a specific antidote. The girl presented with an oedema of the uvula indicating local toxicity, severe bradycardia, first-degree atrioventricular block, drowsiness, and vomiting. Having taken her medical history, we started treatment with atropine, intravenous infusion of dextrose-saline solution and gastroprotection, but it was not successful. Then we introduced digoxin-specific Fab antibody fragments and within two hours, the patient's sinus rhythm returned to normal. Cases of self-poisoning with this oleander are common in South-East Asia, because it is often used as a medicinal herb, and digoxin-specific Fab fragments have already been reported as effective antidote against oleander poisoning there. Our case has taught us that it is important to have this drug in the hospital pharmacy both for digitalis and oleander poisoning.

Language: en

Keywords

Adolescent; Humans; Female; Suicide, Attempted; *Cardiac Glycosides/therapeutic use; *Nerium; *Plant Poisoning/drug therapy/etiology; antidot; antidotes; Antidotes/therapeutic use; common oleander; Digoxin/therapeutic use; Eating; heart block; Immunoglobulin Fab Fragments/therapeutic use; Nerium oleander; oleandrin; oleandrin poisoning; otrovanje; srčani blok; Thevetia peruviana; yellow oleander