Case report, case study
https://doi.org/10.2478/aiht-2023-74-3752
A suicide attempt by ingestion of oleander leaves and treatment with digoxin-specific Fab antibody fragments
Tanja Kovačević
orcid.org/0000-0003-4252-9415
; University Hospital of Split, Department of Paediatrics, Split, Croatia 2 University of Split School of Medicine, Split, Croatia
Branka Polić
; University Hospital of Split, Department of Paediatrics, Split, Croatia 2 University of Split School of Medicine, Split, Croatia
Tatjana Ćatipović Ardalić
orcid.org/0000-0002-8591-0956
; University Hospital of Split, Department of Paediatrics, Split, Croatia 2 University of Split School of Medicine, Split, Croatia
Davor Petrović
; University Hospital of Split, Department of Paediatrics, Split, Croatia 2 University of Split School of Medicine, Split, Croatia
Luka Stričević
; University Hospital of Split, Department of Paediatrics, Split, Croatia 2 University of Split School of Medicine, Split, Croatia
Maja Rogulj
; University Hospital of Split, Department of Psychiatry, Split, Croatia
Joško Markić
orcid.org/0000-0001-9469-9278
; University Hospital of Split, Department of Paediatrics, Split, Croatia 2 University of Split School of Medicine, Split, Croatia
Abstract
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.
Keywords
antidotes; common oleander; heart block; Nerium oleander; oleandrin poisoning; Thevetia peruviana; yellow oleander
Hrčak ID:
311430
URI
Publication date:
15.12.2023.
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