STUDY OF SOCIO CLINICAL, BIOCHEMICAL AND ECG ASPECTS OF YELLOW OLEANDER POISONING

Dr. T. Grashia,MD and Dr. J. Bharath*

ABSTRACT

Introduction: The yellow oleander, an evergreen shrub or a small tree of Apocyananceae family is widely distributed over the tropics. Yellow oleander (Thevetia peruviana), is one of the most poisonous plants which contains numerous toxins .The toxic effects resemble that of digitalis toxicity. The use of seeds or fruits of yellow oleander as a method of self-harm is common in South India. Severely poisoned patients may die in DC shock resistant ventricular fibrillation. It can lead to severe Hyperkalaemia which is a marker of a poor outcome in cardiac glycoside poisoning, which may worsen further toxicity and lead to serious Arrhythmias. Aim & Objectives: To find out the incidence of yellow oleander poisoning and to analyze the socio-clinical aspects. Also to correlate the clinical and biochemical data with electrocardiographic changes. Materials and methods: All patients admitted with consumption yellow oleander poison was studied. The study was carried out over a one year from June 2008 – May 2009. Clinical parameters, CBC, Serum Urea, Creatinine, Serum Na+, Serum K+ and ECG were done to analysis the changes on hourly basis. Results: 160 patients with yellow oleander poisoning were included in the study of which 54 were males and 106 were females. Most patients had consumed oleander in a suicidal intention. 1.73% of patients had underlying psychiatric illness. Case fatality rate was 7.5%. The most common electrocardiographic abnormality was sinus bradycardia. Life threatening arrhythmias were seen in 6.8%. There was significant correlation between outcome and serum potassium levels, bicarbonate levels, and delay in seeking medical attention, and number of symptoms at presentation. There was no correlation between number of seeds consumed and outcome or cardiotoxicity. Oleander seed is still used as a suicidal agent. Oleander plant is easily available as an ornamental plant in urban, semi-urban and rural areas. Highly symptomatic patients and those who has delay in seeking medical attention showed more cardio toxicity. Hence earlier treatment and symptomatic management will help in reducing complications and mortality.

Keywords: Oleander seed, Hyperkalaemia, ECG abnormalities, Cardiac glycoside poisoning.