A study of the clinical profile of yellow oleander poisoning with special reference to electrocardiographic and biochemical abnormalities and outcome at GMKMCH, Salem

Background: Yellow oleander (Thevetia peruviana) seed ingestion can cause cardiac toxicity akin to digoxin overdose, which mainly manifests as bradyarrhythmia. Treatment generally includes intravenous atropine, isoprenaline, and temporary cardiac pacing for severe heart block, as is commonly practiced in Indian hospitals, despite the absence of stringent guidelines. Aims and Objectives: This study aimed to present the clinical profile and outcomes of patients admitted to a tertiary care center in South India with yellow oleander poisoning. Materials and Methods: This observational study was conducted from November 2023 to April 2024 at GMKMCH Salem on 100 patients with yellow oleander poisoning and selected from 176 patients after excluding those with pre-existing cardiac conditions, thyroid disorders, and those on specific medications. Demographic and clinical data were collected and analyzed using the Statistical Package for the Social Sciences software. Results: Most patients (32%) were aged between 21 and 30 years. Normal Electrocardiographic findings were observed in 28% of patients, while 27% exhibited mixed atrioventricular node and sinus node dysfunction, 24% had sinus bradycardia, and 13% had complete heart block (CHB). Temporary venous pacing was required in 43% of cases, with most pacemakers removed within 5 days. The overall mortality rate was 5%, increasing to 7.1% in patients who ingested more than five seeds. Complications included myocarditis (4%) and ventricular arrhythmia (8%). The risks of death (7.1%), CHB (28.6%), and ventricular arrhythmia (10.7%) increased with the consumption of more than five seeds. Conclusion: Yellow oleander poisoning mainly affects young adults and has a 5% fatality rate from myocarditis, cardiogenic shock, and persistent ventricular arrhythmias. While atropine and isoprenaline typically work, the use of anti-digoxin Fab fragments could lessen the requirement for cardiac pacing and enhance patient outcomes.