@article{ref1,
title="Fatal yellow oleander poisoning masquerading as benign candlenut ingestion taken for weight loss",
journal="Journal of emergency medicine",
year="2020",
author="Corcoran, Justin and Gray, Ted and Bangh, Stacey A. and Singh, Veena and Cole, Jon B.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: Candlenuts (Aleurites moluccana) and yellow oleander seeds (Thevetia peruviana) bear a physical resemblance to one another. Candlenuts are benign and marketed as weight loss supplements. Yellow oleander seeds, however, contain toxic cardioactive steroids; as few as 2 seeds may cause fatal poisoning. Because of their physical similarities, the potential for a lethal substitution exists.   CASE REPORT: A 63-year-old woman presented to the emergency department with vomiting after ingesting 5 of what she believed to be candlenuts that were ordered online under the colloquial name &quot;Nuez de la India&quot; for the purpose of weight loss. She was bradycardic (nadir pulse of 30 beats/min) and hyperkalemic (serum potassium 7.3 mEq/L). Within hours of presentation she suffered a ventricular fibrillation arrest, followed by a terminal asystolic arrest. Postmortem analyses of liver tissue and the seeds were consistent with fatal T. peruviana poisoning.   WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: T. peruviana seeds contain toxic cardioactive steroids; their physical resemblance to candlenuts poses a risk of potentially fatal substitution. Therapy with high-dose digoxin specific immune fragments (20-30 vials) may be helpful.<p /> <p>Language: en</p>",
language="en",
issn="0736-4679",
doi="10.1016/j.jemermed.2020.07.026",
url="http://dx.doi.org/10.1016/j.jemermed.2020.07.026"
}