RESUMEN
Background: Poisoning with Thevetia peruviana (yellow oleander) is commonly observed in Northern and Eastern provinces of Sri Lanka causing significant morbidity and mortality. It contains cardiac glycosides which are toxic to cardiac muscle that results in cardiovascular dysrhythmias. Objective: To determine the pattern of cardiac dysrhythmias and outcome of yellow oleander poisoning at a tertiary care center of Northern Sri Lanka. Methods: A descriptive, cross sectional, prospective study was carried among patients with yellow oleander poisoning admitted to Teaching hospital, Jaffna, Sri Lanka over a period of two years. Twelve lead standard electrocardiography and 2‑lead ECG monitoring were performed in all patients during the hospital stay at the cardiology unit. Data were entered in Microsoft Excel sheet and was analyzed using SPSS [version 21] analytical package. Results were presented as counts, percentages and mean ± SD for continuous variables. Results: 23 out of 44 patients were females. Mean age of the patients was 24.84 [SD ± 0.43] years. Most of the patients were symptomatic and presented with gastro intestinal symptoms like vomiting, abdominal pain and diarrhea. Bradycardia was the most commonly observed cardiac rhythm abnormality within the first 24 hrs of ingestion of yellow oleander seeds. Sinus bradycardia [75%] was the commonest cause for bradycardia. All patients were treated with multiple doses of activated charcoal irrespective of the time of presentation. Patients with bradyarrhythmias were treated with intravenous boluses of atropine and 12 of them needed temporary pacing. Conclusion: Most of the victims of Yellow oleander poisoning were young adults. The cardiac toxicity developed within 24 hours of ingestion of the seeds. The risk of toxicity has not related to the number of seeds consumed. Most patients have nonspecific symptoms. AV conduction abnormalities are common. Activated charcoal is useful in most cases.
RESUMEN
Introduction: 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. Materials and 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 24hrs 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.