Author(s): Sankar Selvaraj1, Prince Sreekumar Pius2, Suresh Kumar3, Benitta Mary Redleene4
Yellow oleander (Cascabela thevetia) is a poisonous plant that is widely found in India. All parts of the C. thevetia plant are
toxic to humans as they contain cardiac glycosides.
MATERIALS AND METHODS
100 patients with alleged history of yellow oleander seed poisoning who came to Kanyakumari Government Medical College
Hospital during the period of 2013-16 were enrolled in this study. Patients presenting with multiple poison consumption and
those with previous history of heart disease were excluded from the study. A detailed history of the number of seeds consumed,
the time of consumption, detailed clinical assessment, routine blood investigations and a 12-lead ECG were recorded. ECG was
recorded at the time of admission and every 12th hourly to detect any cardiac arrhythmias.
Most symptomatic patients had conduction defects affecting the SA node, the AV node or both. Patients showing cardiac
arrhythmias had significantly higher mean serum potassium concentrations ranging from 4.5-5.2 mEq/L. Yellow oleander seed
poisoning is common among young females (56%). There is a poor correlation between the number of seeds ingested and
the severity of cardiotoxicity. Arrhythmias has occurred after ingestion of one or two seeds; some patients are asymptomatic
even after consuming five or more seeds without requiring specialised treatments. This could be explained on the basis that
crushed seeds are more dangerous than whole seeds.
Most of these young previously healthy patients had conduction defects affecting the SA or AV nodes. Relatively, few had the
atrial tachyarrhythmias or ventricular ectopic beats that are typical of digoxin poisoning. Yellow oleander induced arrhythmias
were associated with high serum potassium levels when compared to patient without arrhythmias.