title: Acute yellow oleander (Thevetia peruviana) poisoning: cardiac arrhythmias, electrolyte disturbances, and serum cardiac glycoside concentrations on presentation to hospital.
abstract: OBJECTIVE
  To describe the cardiac arrhythmias, electrolyte disturbances, and serum cardiac glycoside levels seen in patients presenting to hospital with acute yellow oleander (Thevetia peruviana) poisoning and to compare these with published reports of digitalis poisoning.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Medical wards of Anuradhapura District General Hospital, Sri Lanka, and coronary care unit of the Institute of Cardiology, National Hospital of Sri Lanka, Colombo, the national tertiary referral centre for cardiology.
  
  
  METHODS
  351 patients with a history of oleander ingestion.
  
  
  METHODS
  ECG and blood sample analysis on admission.
  
  
  RESULTS
  Most symptomatic patients had conduction defects affecting the sinus node, the atrioventricular (AV) node, or both. Patients showing cardiac arrhythmias that required transfer for specialised management had significantly higher mean serum cardiac glycoside and potassium but not magnesium concentrations. Although there was considerable overlap between groups, those with conduction defects affecting both sinus and AV nodes had significantly higher mean serum cardiac glycoside levels.
  
  
  CONCLUSIONS
  Most of these young previously healthy patients had conduction defects affecting the sinus or AV nodes. Relatively few had the atrial or ventricular tachyarrhythmias or ventricular ectopic beats that are typical of digoxin poisoning. Serious yellow oleander induced arrhythmias were associated with higher serum cardiac glycoside concentrations and hyperkalaemia but not with disturbances of magnesium.
authors.affiliation: Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Headington, Oxford OX3 9DU, UK.
authors.forename: M
authors.initials: M
authors.lastname: Eddleston
authors.forename: C A
authors.initials: CA
authors.lastname: Ariaratnam
authors.forename: L
authors.initials: L
authors.lastname: Sjöström
authors.forename: S
authors.initials: S
authors.lastname: Jayalath
authors.forename: K
authors.initials: K
authors.lastname: Rajakanthan
authors.forename: S
authors.initials: S
authors.lastname: Rajapakse
authors.forename: D
authors.initials: D
authors.lastname: Colbert
authors.forename: W P
authors.initials: WP
authors.lastname: Meyer
authors.forename: G
authors.initials: G
authors.lastname: Perera
authors.forename: S
authors.initials: S
authors.lastname: Attapattu
authors.forename: S A
authors.initials: SA
authors.lastname: Kularatne
authors.forename: M R
authors.initials: MR
authors.lastname: Sheriff
authors.forename: D A
authors.initials: DA
authors.lastname: Warrell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000097:blood / Q000139:chemically induced*; D002301:Cardiac Glycosides / Q000097:blood*; D002648:Child; D004071:Digitalis Glycosides / Q000506:poisoning*; D004573:Electrolytes / Q000097:blood*; D005260:Female; D006321:Heart / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D013188:Sri Lanka
chemical_list: D002301:Cardiac Glycosides; D004071:Digitalis Glycosides; D004573:Electrolytes