A non-fatal oleander poisoning.
The study presents a case of non-fatal poisoning with oleander blooms in a 47-year-old female, with emphasis on the importance of toxicological service in a clinical emergency. After repeated vomiting at home, the patient was admitted at the hospital with cardiac symptoms more than 18 h after the ingestion. Serum samples were assayed immunochemically for digitoxin-related compounds by electrochemiluminescent immunoassay, and using HPLC/MS/MS analysis for oleandrin, the main cardiac glycoside of Nerium oleander. Confirming the non-specific immunoassay results, which are often clinically over-interpreted, oleandrin was detected by HPLC/MS/MS in the serum sample in a concentration of 1.6 ng/ml upon admission. Comparison with previous reports indicates that single compound analysis only permits a toxicological assessment for oleander poisoning and results in the proposal to classify an oleandrin level between 1.0 and 2.0 ng/ml as toxic blood plasma/serum concentration.
Pietsch
J
J
Institute of Legal Medicine, Medical Faculty Carl Gustav Carus, Dresden Technical University, Fetscherstr. 74, 01307, Dresden, Germany. Joerg.Pietsch@mailbox.tu-dresden.de
Oertel
R
R
Trautmann
S
S
Schulz
K
K
Kopp
B
B
Dressler
J
J
D002298:Cardenolides / Q000032:analysis*; D002851:Chromatography, High Pressure Liquid / Q000379:methods*; D005260:Female; D006801:Humans; D007118:Immunoassay / Q000379:methods*; D008163:Luminescent Measurements / Q000379:methods*; D013058:Mass Spectrometry / Q000379:methods*; D008875:Middle Aged; D030007:Nerium / Q000506:poisoning*; D011041:Poisoning / Q000175:diagnosis; D012680:Sensitivity and Specificity
D002298:Cardenolides; C021065:oleandrin