Title: Acute oleander poisoning – A study of clinical profile from a tertiary care centre in South India

Biography:

Karthik Gunasekaran is currently working as an Assistant Professor in the Department of General Medicine with the unit focusing on clinical toxicology. His research revolves around the common public health concerns in the tropics, remarkably on tropical infections like scrub typhus, pesticide and other forms of toxin consumption. He has participated in national and international conferences. His other areas of clinical expertise include the use of medical sonology for bedside assessment of critically ill patients.

Abstract

Background: The yellow oleander (Thevetia Peruviana) is common throughout the tropics with all parts of the plant having high concentrations of cardiac glycosides (thevetins A and B and neriifolin) that are toxic to cardiac muscle and the autonomic nervous system. Here we describe a cohort of patients with oleander poisoning and their outcomes.

Methods & Materials: This historic cohort study was conducted over a period of 12 months (July 2016 to June 2017). Data was extracted from the inpatient medical records and analyzed. A diagnosis of acute oleander poisoning was made on patients with history of consumption of the poison and with clinical symptoms of acute oleander toxicity. Descriptive statistics were obtained for all variables in the study. Statistical tests to ascertain significance was used appropriately.

Results & Conclusions: The study cohort comprised of 30 patients with a mean±SD age of 30.77±12.31 and presenting at 12.29±8.48 (mean±SD) hours after consumption. Gastric emesis (80%) was the most common symptom. Admission APACHE-II score was 5.30±5.06. Metabolic abnormalities include hyperchloremia (112.14±3.77) and metabolic acidosis (bicarbonate<24 mmol/L), (19.23±3.07). 15 patients (50%) had normal ECG; second degree AV block (13.3%), sinus bradycardia (10%) and T wave abnormality (10%) were observed. 15 patients (50%) required temporary pacemaker insertion (TPI) for duration of 4.00±1.85 days. The mortality in the cohort was 2 (6.7%). TPI significantly prolonged the duration of hospital stay (OR-28, p<0.002).

Conclusion: Oleander poisoning leads to significant morbidity in South India. Dyselectrolytemia with ECG abnormalities is common among these patients. TPI insertion prolonged the duration of hospital stay; further studies are required to know the indication and the effect of temporary pacing on survival.