Oleander toxicity – the clinical spectrum and mortality predictors: an observational study

Abstract

A major cause of mortality in Government Villupuram Medical College & Hospital is due to toxin exposure. Oleander poisoning ranks second in the list being superseded only by organophosphate poisoning. Data on the incidence, clinical features and the determinants of mortality are scanty. Standardized treatment or monitoring protocols are lacking. The study aimed to identify key mortality predictors in oleander poisoning, document the clinical spectrum of patients presenting with oleander poisoning and to devise a standard assessment protocol in oleander-poisoned patients. This is a prospective, observational study conducted at Villupuram Medical College. Consecutive hospitalized patients who had consumed oleander seeds, fruits or leaves were included in the study after obtaining informed, written consent. Upon registration, detailed history, clinical examination, baseline investigations and targeted investigations were performed. The data were documented in the standardized case proforma and subsequently computed. Patients were followed up 12 hourly by clinical examination and ECG recordings for a duration of 3 days. The data were analyzed using standard statistical methods. A total of 101 patients (46 male and 55 female) were enrolled into the study. There were 18 deaths, most of them (82.55%) occurring within 24 hours of intake. Among the parameters assessed, females, low BMI (Body Mass Index), consumption of > 3 seeds, delayed presentation (after 120 minutes), altered mental status, clinical shock, presence of heart block and absent p waves in ECG were significantly associated with mortality. Males, high BMI, low dosage of poison (<=3 seeds) and hemodynamic stability on day 1 were associated with favorable outcomes. ST-T segment changes, sinus tachycardia, ventricular premature contractions and administration of orciprenaline had no significant effect on the outcome. Oleander poisoning claims lives in the rural tropics. Institutional assessment and treatment protocols based on the infrastructure and expertise available are the need of the hour. Prompt first aid, critical assessment and timely referral for cardiac pacing can cut down mortality to a large extent.

Keywords: Oleander poisoning; Cardiac glycoside toxicity; Mortality predictors