Yellow oleander poisoning in eastern province: an analysis of admission and outcome.
BACKGROUND
Cardiac toxicity after self-poisoning from ingestion of yellow oleander seeds is common in Eastern Sri Lanka.


OBJECTIVE
To determine the clinical manifestations, cardiac arrhythmias, electrolytes abnormalities and outcome of management using currently available treatment, Poisoning Unit, Tertiary Care Hospital in Eastern Sri Lanka.


METHODS
We studied 65 patients [Mean age : 23(± 0.43)yrs], (Male: Female=27:38) with yellow oleander poisoning (YOP) admitted to a Poisoning Unit, Tertiary Care Hospital in Eastern Sri Lanka from January to December 2011.


RESULTS
Most patients are symptomatic who presented with classical symptoms of vomiting, abdominal pain and diarrhea. Cardiac dysrhythmias such as bradycardia or an irregular pulse are the most common findings on examination. 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 serum potassium concentrations. Almost all patients were treated with multiple activated charcoal even late presentation. Patients with brad arrhythmias were treated with intravenous boluses of atropine and intravenous infusions of isoprenaline. Temporary cardiac pacing was done for those not responding to drug therapy. There were two deaths (3.07%), both had third-degree heart block. They died even definitive treatment could be instituted. Of the remaining 63 patients, 54 (83.1%) patients required treatment, and 29 were treated with only atropine and/or isoprenaline while one required cardiac pacing in addition. 12 (18.4%) patients had arrhythmias that were considered life threatening (second-degree heart block type II, third-degree heart block and nodal bradycardia). They had good recovery even though they had developed cardiac toxicity.


CONCLUSIONS
YOP are common among young females. The cardiac toxicity develops within 24 hrs of ingestion of YO seeds. The risk of toxicity has negative correlation with number of seeds. Most patients have nonspecific symptoms. AV conduction defects are common. Multiple activated charcoals alone were safe and adequate in most cases even late presentation.
Selladurai
S
Pirasath
Consultant Cardiologist, Department of Cardiology, Teaching Hospital, Batticaloa, Sri Lanka.
Kanagasingam
K
Arulnithy
D015746:Abdominal Pain / Q000139:chemically induced; D000293:Adolescent; D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000139:chemically induced*; D002606:Charcoal / Q000627:therapeutic use; D003967:Diarrhea / Q000139:chemically induced; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced / Q000188:drug therapy; D008297:Male; D011041:Poisoning / Q000188:drug therapy; D012639:Seeds / Q000506:poisoning; D013188:Sri Lanka; D013406:Suicide, Attempted; D031052:Thevetia / Q000506:poisoning*; D014839:Vomiting / Q000139:chemically induced; D055815:Young Adult
D000889:Anti-Arrhythmia Agents; D002606:Charcoal