Key result
Oleander ingestion produced a falsely elevated serum digoxin concentration of 5.8 ng/mL due to cross-reactivity between oleander glycosides and digoxin in the radioimmunoassay.
Case Report (n=1)
Oleander ingestion can cause fatal ventricular arrhythmias and falsely elevate serum digoxin levels due to cross-reactivity in radioimmunoassays.
May prompt alternative assays in unexplained digoxin elevations; leaves open need for confirmatory methods beyond single 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. (JAMA1982;247:1596-1597)
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J. Osterloh (1982) conducted a case report in Oleander poisoning (n=1). Oleander ingestion was evaluated on Serum digoxin concentration and cross-reactivity. Oleander ingestion produced a falsely elevated serum digoxin concentration of 5.8 ng/mL due to cross-reactivity between oleander glycosides and digoxin in the radioimmunoassay.
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