Key result
Ingestion of oleander leaves produced a falsely elevated serum digoxin concentration of 5.8 ng/mL due to cross-reactivity of oleander glycosides in the digoxin radioimmunoassay.
Case Report (n=1)
Oleander ingestion can cause fatal arrhythmias and produce falsely elevated serum digoxin concentrations due to cross-reactivity in radioimmunoassays.
Alerts clinicians to spurious digoxin elevations in oleander exposure; leaves open assay-specific validation in plant glycoside cases.
An elderly woman allegedly ingested oleander leaves and died. Ventricular arrhythmias and asystole were unresponsive to cardiopulmonary resuscitation, pharmacologic agents, and cardioversion. The patient, who had no access to digoxin, had an initial serum digoxin concentration of 5.8 ng/mL. Cross-reactivities between oleander extract and pure oleandrin and digoxin in the digoxin radioimmunoassay were 100:1 and 29,000:1, respectively. We postulate that glycosides in oleander leaves produced the elevated serum digoxin concentration. Based on an assumed volume of distribution of the oleander glycosides of 1 L/kg, the calculated lethal dose absorbed by our patient was 200 times greater than lethal doses in several animal species and corresponded to the absorption of 4 g of oleander leaves.
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John Osterloh (1982) conducted a case report in Oleander poisoning (n=1). Oleander leaves ingestion was evaluated on Serum digoxin concentration and cross-reactivity in digoxin radioimmunoassay. Ingestion of oleander leaves produced a falsely elevated serum digoxin concentration of 5.8 ng/mL due to cross-reactivity of oleander glycosides in the digoxin radioimmunoassay.
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