title: A fatal case of oleandrin poisoning.
abstract: The study presents a case of fatal poisoning with oleander leaves in an adult diabetic male. After repeated vomiting, and gastrointestinal distress the patient was admitted at the hospital with cardiac symptoms 1h after the ingestion. Urine samples were assayed immunochemically and by GC-MS for drugs of abuse and for general toxicological screen. Blood was analyzed for alcohol and volatiles by static head space GC-MS. Blood and oleander leaves were analyzed by LC-MS/MS for oleandrin and related compounds, the main cardiac glycosides of Nerium oleander. Oleandrin was detected by LC-MS/MS in the blood sample at a concentration of approximately 10 ng/ml. Another cardiac glycoside with pseudo-molecular ion of m/z 577, a likely structural isomer of oleandrin, was also detected in the blood and oleander leaves. However, by using the response as a function of concentration for oleandrin, this cardiac glycoside was roughly estimated at a concentration of approximately 10 ng/ml in the deceased blood. This would give a total fatal blood concentration of cardiac glycosides of about approximately 20 ng/ml in the deceased blood.
authors.affiliation: Department of Forensic Evidence, Forensic Science Laboratory, Abu Dhabi, PO Box 253, United Arab Emirates. iawasfi@yahoo.com
authors.forename: Ibrahim A
authors.initials: IA
authors.lastname: Wasfi
authors.forename: Omar
authors.initials: O
authors.lastname: Zorob
authors.forename: Nawal A
authors.initials: NA
authors.lastname: Al katheeri
authors.forename: Anwar M
authors.initials: AM
authors.lastname: Al Awadhi
mesh_terms: D002298:Cardenolides / Q000097:blood / Q000506:poisoning*; D003920:Diabetes Mellitus / Q000188:drug therapy; D053593:Forensic Toxicology; D008401:Gas Chromatography-Mass Spectrometry; D006323:Heart Arrest / Q000139:chemically induced; D006327:Heart Block / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000139:chemically induced; D008517:Phytotherapy / Q000009:adverse effects*; D018515:Plant Leaves / Q000506:poisoning; D014693:Ventricular Fibrillation / Q000139:chemically induced
chemical_list: D002298:Cardenolides; C021065:oleandrin