April 24, 2010

Oleander Poisoning….this too needs to be eradicated?

Filed under: MedPosts — alokgarg47 @ 11:33

Well, this is my very first post…and this is about the case in my exams!!

Actually i got this case twice as i opted for the same during my pediatric exam too.

Both the cases were females….there seems to be some female predisposition here of 2:0 :)…

The first case was a 20 yr old woman…took oleander after fight with boyfriend and 2nd, quite interesting, took it when not allowed to ride a scooter….yes this is a 13 yr old girl…(she told me that she was tasting the seeds!). There seems to be a reason for Oleander to get banned!!

Well, there is nothing special to be mentioned in the history…so am just gonna skip the rest of it to Symptoms.

Both the cases were not so complicated (maybe they just took it to fulfill there wishes….the 2nd girl had only two seeds). They both presented with nausea and vomiting(chief complaint)…and some numbness of feet. Oleander causes some numbness of extremities due to blockage of receptors. It can also cause contact dermatitis. On examination, the pulse was decreased (less than 60 in both cases) and hypotension. This is the most important manifestation of the toxin. With lethal doses, it can also cause heart block. Other manifestation are secondary to bradycardia and heart block (e.g. dyspnea, respiratory distress).

I should include the common causes of bradycardia here (as i was questioned in the viva). These include- beta blockers (most important diagnosed cause), hypothyroidism, athletes, CCBs, digoxin etc etc.

As there is no specific antidote for Oleander poisoning, treatment is symptomatic. (Digoxin Fab has been tried with some success).

Management includes Gastric lavage (also activated charcoal), management of airway and the most importantly therapy with beta-agonists. Most commonly, isoprenaline is used by IV route and is given 0.1-1.0 microlitres/kg/min. This is continued till the heart rate is stabilized. Also, atropine can be tried (2nd line as has many adverse effects).

Prognosis is good with adequate treatment (both the patients survived!!)…and also the 2nd patient got a scooter for herself (here the prognosis seems very good 🙂 )


Hello world!

Filed under: Welcome — alokgarg47 @ 06:47

Whoa!! finally have started a new blog.

This is about some patients i have encountered during my medicine clinic rounds….

Welcome aboard…

Hopefully i will add more categories into it…

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