title: Cardiovascular glycoside-like intoxication following ingestion of Thevetia nereifolia/peruviana seeds: a case report.
abstract: Some plants contain glycoside compounds which determine cardiovascular symptoms similar to those observed after acute toxic digoxin administration. The present case report involves a patient who showed important cardiovascular symptoms following the ingestion of Thevetia nereifolia/peruviana seeds. About 30 min after ingestion, a 65-year-old man presented with dizziness, giddiness, numbness and a burning sensation, diarrhea, sweating, vomiting and ECG changes. At the time of admission he presented with tremors; his body temperature was 37 degrees C, and blood analysis gave the following results: K 5.6 mEq/l, myoglobin 176 IU, troponin T 0.10 ng/ml, PO2 69 mmHg, PCO2 37.4 mmHg, pH 7.33, HCO3- 19.9 mEq/l, hemoglobin 14.8 g/dl, saturation 92.5%. Echocardiography showed a left ventricle with normal global and segmentary contractility. The following days, the patient showed a reduction, until total resolution, of the atrioventricular block and of the alterations of the ST segment. The ectopic beats also resolved; K value before discharge was 4.4 mEq/l. On the third day, the serum levels of digoxin were 0.15 ng/ml. This case report is important because it describes all the cardiovascular and non-cardiovascular signs of glycoside toxicity in an adult patient who accidentally swallowed only two seeds (non-fatal dose) of Thevetia.
authors.affiliation: Division of Cardiology Paolo Borsellino, G.F. Ingrassia Hospital, Via Val Platani, 3 90144 Palermo.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Maringhini
authors.forename: Lucio
authors.initials: L
authors.lastname: Notaro
authors.forename: Ottavio
authors.initials: O
authors.lastname: Barberi
authors.forename: Alfonso
authors.initials: A
authors.lastname: Giubilato
authors.forename: Raffaella
authors.initials: R
authors.lastname: Butera
authors.forename: Pietro
authors.initials: P
authors.lastname: Di Pasquale
mesh_terms: D000368:Aged; D001919:Bradycardia / Q000209:etiology; D002301:Cardiac Glycosides / Q000506:poisoning*; D004562:Electrocardiography; D006327:Heart Block / Q000209:etiology; D006801:Humans; D008297:Male; D010939:Plant Poisoning / Q000150:complications*
chemical_list: D002301:Cardiac Glycosides