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Case Reports
. 2023 Dec 29;74(4):292-295.
doi: 10.2478/aiht-2023-74-3752. eCollection 2022.

A suicide attempt by ingestion of oleander leaves and treatment with digoxin-specific Fab antibody fragments

Tanja Kovačević  1   2 , Branka Polić  1   2 , Tatjana Ćatipović Ardalić  1   2 , Davor Petrović  1   2 , Luka Stričević  1   2 , Maja Rogulj  3 , Joško Markić  1   2
Affiliations
Case Reports

A suicide attempt by ingestion of oleander leaves and treatment with digoxin-specific Fab antibody fragments

Tanja Kovačević et al. Arh Hig Rada Toksikol. .

Abstract
in English, Slovenian

Natural cardiac glycosides have positive inotropic heart effects but at high, toxic doses they can cause life-threatening cardiac arrhythmias. Here we present the first Croatian case of a 16-year-old girl who attempted suicide by eating dried oleander leaves, which contain natural cardiac glycosides, and her treatment with a specific antidote. The girl presented with an oedema of the uvula indicating local toxicity, severe bradycardia, first-degree atrioventricular block, drowsiness, and vomiting. Having taken her medical history, we started treatment with atropine, intravenous infusion of dextrose-saline solution and gastroprotection, but it was not successful. Then we introduced digoxin-specific Fab antibody fragments and within two hours, the patient's sinus rhythm returned to normal. Cases of self-poisoning with this oleander are common in South-East Asia, because it is often used as a medicinal herb, and digoxin-specific Fab fragments have already been reported as effective antidote against oleander poisoning there. Our case has taught us that it is important to have this drug in the hospital pharmacy both for digitalis and oleander poisoning.

Prirodni srčani glikozidi imaju pozitivan inotropni učinak na srce. U visokim, toksičnim dozama mogu prouzročiti za život opasne srčane aritmije. Predstavljamo prvi hrvatski slučaj pokušaja samoubojstva 16-godišnje djevojke konzumiranjem oleandrovih suhih listova, koji sadrže prirodne srčane glikozide, i liječenje specifičnim protuotrovom. Djevojka je također imala edem uvule kao znak lokalne toksičnosti. Svi podatci dobiveni su analizom dokumentacije iz medicinskoga kartona. U djevojke se javila značajna bradikardija, atrioventrikularni blok prvog stupnja, pospanost i povraćanje. Početno liječenje atropinom, intravenskom infuzijom fiziološke otopine i 5 % glukoze uz gastroprotekciju nisu bili učinkoviti. Pacijentica je zatim liječena digoksin-specifičnim Fab imunoglobulinskim fragmentima. Unutar dva sata od primjene lijeka srčani se ritam promijenio u normalni sinusni ritam. Ovo je rijedak slučaj pokušaja suicida samootrovanjem na našim prostorima. Slučajevi samootrovanja ovom biljkom česti su u jugoistočnoj Aziji jer se ondje često koristi kao biljni proizvod za samoliječenje. Digoksin specifični Fab fragmenti su protuotrov za predoziranje digoksinom, kao i za akutnu intoksikaciju ovom biljkom. Važno je imati ovaj lijek u bolničkoj ljekarni kako za intoksikaciju digitalisom tako i za otrovanje ovom biljkom.

Keywords: Nerium oleander; Thevetia peruviana; antidot; antidotes; common oleander; heart block; oleandrin; oleandrin poisoning; otrovanje; srčani blok; yellow oleander.

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Conflict of interest statement

Conflict of interest

None to declare.

References

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