Anti-digoxin Fab fragments in cardiotoxicity induced by ingestion of yellow oleander: a randomised controlled trial
The LancetPublished 1 March 2000
Michael Eddleston, Senaka Rajapakse, Rajakanthan, S Jayalath, Lena Sjöström, Wijeyasingam Santharaj
Citations178
SJR quartileQ1
SJR score12.11
SNIP22.72
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TL;DR
Anti-digoxin Fab fragments are a safe and effective treatment for serious cardiac arrhythmias induced by yellow oleander and their use in small rural hospitals in Sri Lanka should minimise costly transfer of patients and reduce the numbers of deaths.
Abstract
Anti-digoxin Fab fragments are a safe and effective treatment for serious cardiac arrhythmias induced by yellow oleander. Their use in small rural hospitals in Sri Lanka should minimise costly transfer of patients and reduce the numbers of deaths; however, further study will be required to confirm this reduction.
Keywords
Medicine
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Single-dose activated charcoal should not be administered routinely in the management of poisoned patients and unless a patient has an intact or protected airway, the administration of charcoal is contraindicated.
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Small children and domestic livestock are at increased risk of oleander poisoning, and experimental and established therapeutic measures involved in detoxification are discussed.
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For many years, the Food and Drug Administration regulated botanical dietary-supplement ingredients, in most circumstances, under the provisions for food additives of the Federal Food, Drug, and Cosmetic Act to ensure that they were safe and wholesome.
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Digoxin-specific antibody fragments were generally well tolerated and clinically effective in patients judged by treating physicians to have potentially life-threatening digitalis intoxication and sought additional, voluntarily reported clinical data pertaining to treatment through 3 week follow-up.
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There is an urgent need for an intervention which could be used in rural hospitals, thus preventing the hazardous and expensive emergency transfer of patients to the capital.
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This drug provides the clinician with a rapidly acting, safe antidote for all commonly used digitalis preparations, and provides a needed safety net for the continuing use of cardiac glycosides as first-line inotropic agents in the modern therapy of chronic CHF.
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A 37-year-old man presented two hours after the ingestion of "a handful" of oleander leaves in a suicide attempt with cardiotoxicity evidenced by the presence of bradycardia with sinoatrial nodal arrest and junctional escape consistent with a cardiac glycoside effect.
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This case demonstrates the cross-reactivity between the cardiac glycosides in oleander and the digoxin radioimmunoassay, and indicates that digoxin-specific Fab antibody fragments might prove to be lifesaving inOleander poisoning.
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It is postulate that glycosides in oleander leaves produced the elevated serum digoxin concentration and the calculated lethal dose absorbed by the patient was 200 times greater than lethal doses in several animal species and corresponded to the absorption of 4 g of oleanders leaves.
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It is concluded that repeated doses of charcoal enhance the clearance of digoxin and should be considered for use in digoxin toxicity.
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It is recommended that Fab be used in the treatment of digitalis poisoning in infants and young children who have ingested greater than or equal to 0.3 mg of digoxin per kilogram, who have underlying heart disease, or who have a serum digoxin concentration of greater than and equal to 6.4 nmol per liter in the elimination phase.
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82 Citations1996R. Brubacher Jeffrey, R. Ravikumar Padinjarekuttu +3 more
To the knowledge, this is the first reported use of digoxin Fab fragments to treat toad venom poisoning, and it was found that it was identical to Chan Su, a Chinese medication made from toad Venom.
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Large doses of digoxin-specific Fab fragments (dsFab) are efficacious in the treatment of dysrhythmias in this canine model of N oleander cardiac glycoside poisoning.
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170 cases of Thevetia poisoning admitted to the Teaching Hospital, Jaffna in the North of Sri Lanka are studied and the action of the cardiac glycoside in ThevetIA is clearly demonstrated.
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In a fatal (cardiotoxic) case of oleander extract poisoning of a young female, ethanol extracts of blood and tissue homogenates were purified by lead acetate and oleandrin was extracted into chloroform.
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62 Citations1979Douglas V. Shaw, John Pearn
A seven‐year total population survey from south‐east Queensland has revealed that, in practice, the rate of clinical poisoning due to oleander is inconsequential, and mortality is negligible.
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The value of digoxin-specific Fab antibody fragments in the treatment of plant glycoside and, in particular, oleander intoxication is discussed.
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A fatal yellow oleander herbal poisoning is reported in a 2 1/2-year-old Melanesian boy, who had persistent vomiting, Bradycardia caused by complete heart block, hyperkalemia and cardiac glycosides detected in his serum.
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Patients of suicidal poisoning with seeds of yellow-oleander had gastro-intestinal as well as cardiovascular toxic effects and cause of death in all the patients was cardiogenic shock.
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