A Study on Incidence, Clinical Profile and Outcome of Cardiac Dysrhythmias in Yellow Oleander Poisoning

ABSTRACT

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.