ABSTRACT
Introducción: Las intoxicaciones por plantas son infrecuentes, de complicada orientación diagnóstica, que en general, se dificulta la identificación de la planta, su potencial tóxico y el tratamiento específico. Entre ellas la adelfa, capaz de producir cuadros de intoxicación grave, como un caso consultado a la guardia del Centro Nacional de Toxicología. Objetivos: Presentar un caso clínico de intoxicación grave por adelfa. Caso clínico: Paciente adulto, con intranquilidad, vómitos, dolores abdominales, tensión arterial 150/90 mmHg, frecuencia cardiaca y respiratoria normales, refirió que había consumido vía oral y rectal una poción elaborada con una planta, como tratamiento antiparasitario. El médico de guardia decidió comunicarse con el Centro Nacional de Toxicología. Se identificó la planta como adelfa. A pesar de la aplicación de reposición de volumen, lavado gástrico y la administración de carbón activado; presentó bloqueo auriculoventricular, extrasístoles aisladas y bradicardia. Se suministró atropina endovenosa, luego se trasladó hacia la unidad de cuidados intensivos y posteriormente egresó. Conclusiones: El caso presentó una intoxicación aguda grave por adelfa, con un correcto diagnóstico y tratamiento, que requirió de la labor conjunta de los médicos del cuerpo de guardia del hospital, la terapia intensiva y del Centro Nacional de Toxicología(AU)
Introduction: Poisoning by plants is infrequent, with a complicated diagnostic orientation, which in general makes it difficult to identify the plant, its toxic potential and specific treatment. Among them the oleander, capable of producing serious intoxication, as a case consulted to the National Toxicology Center. Objectives: To present a clinical case of severe oleander poisoning. Clinical case: Adult patient with restlessness, vomiting, abdominal pain, blood pressure 150/90 mmHg, normal heart and respiratory rates, and reported that he had consumed orally and rectally a potion made with a plant, as an antiparasitic treatment. The doctor who assisted him decided to communicate with the National Toxicology Center. The plant was identified as oleander. Despite the application of volume replacement, gastric lavage and the administration of activated charcoal; the patient presented atrioventricular block, isolated extrasystoles and bradycardia, intravenous atropine was administered, and subsequent transfer to the intensive care unit, and later he was discharged. Conclusions: The case presented a severe acute oleander poisoning, there was correct diagnosis and treatment, which required the joint work of the doctors from hospital emergency, the intensive care unit and the National Toxicology Center(AU)
Subject(s)
Humans , Male , Adult , Psychomotor Agitation , Toxicology , Blood Pressure , Critical Care , Cardiac Complexes, Premature , Atrioventricular Block , Antiparasitic AgentsABSTRACT
Background: Cardiac toxicity after self-poisoning from ingestion of yellow oleander seeds is a common toxicological emergencyin South India.Objectives: The objectives of this study were to identify the various cardiac arrhythmias and electrolyte abnormalities in yellowoleander poisoning. This study was also designed to identify the clinical and biochemical parameters at presentation whichcan predict serious arrhythmias.Materials and Methods: This was a observational study among 111 patients who attended our emergency department afterconsuming yellow oleander seeds. Clinical, biochemical, electrocardiographic, and treatment details were collected from thepatients and recorded. Patients were monitored with serial electrocardiograms (ECGs).Results: Oleander seed poison was most prevalent in the 20–40 years of age. Incidence was more among the young females.ECG abnormalities were found in majority of the individuals. More the crushed seeds consumed and delay to admission to thehospital, poorer was the outcome. All symptomatic patients had conduction defects affecting the sinus node, atrioventricularnode, or both. Patients showing cardiac arrhythmias that required specific management had significantly higher serumpotassium concentrations. At presentation, 21 patients had serious arrhythmias, and on follow-up, 4 developed new-onsetserious arrhythmia. Sinus bradycardia (41.8%) was the most common arrhythmia followed by segment-wave changes (33%).Mortality rate was 1.9%.Conclusions: The arrhythmias produced by this poisoning might range from sinus bradycardia to complete heart block andventricular tachycardia. Although serum potassium correlated significantly with serious dysrhythmias, it did not predict thedevelopment of new-onset serious arrhythmia. On the whole, serious dysrhythmias were significantly associated with ingestionof crushed seeds, delay in admission, hyperkalemia.