Severe symptomatic bradycardia after a dinner of spicy oleander soup

  • Andrea Tampieri | andrea.tampieri@libero.it Emergency Department, S.M. Scaletta Hospital, Imola (BO), Italy.
  • Fabrizio Mucci Emergency Department, S.M. Scaletta Hospital, Imola (BO), Italy.
  • Valeria Palmonari Emergency Department, S.M. Scaletta Hospital, Imola (BO), Italy.
  • Eugenio Giovannini Emergency Department, S.M. Scaletta Hospital, Imola (BO), Italy.
  • Tiziano Lenzi Emergency Department, S.M. Scaletta Hospital, Imola (BO), Italy.
  • Patrizia Cenni Emergency Department, S.M. Scaletta Hospital, Imola (BO), Italy.

Abstract

Cardiac glycosides similar to digoxin are produced by different plants in nature. Nerium oleander, commonly grown as an ornamental shrub, can be found worldwide in temperate countries. Intentional or accidental ingestion of any part of the plant can lead to clinically relevant intoxication. A 63-year-old woman came to the emergency department with acute dyspeptic symptoms after eating vegetable soup flavored with unfamiliar flowers she have collected herself. However, the electrocardiography (ECG) showed abnormalities that raised suspicions for an overdose of digoxin-like cardiac glycosides. The patient was not on treatment with digoxin and a careful anamnesis revealed that she had eaten oleander leaves. Digoxin specific Fab antibody fragments were administered for marked bradycardia that was not responding to atropine administration, after counseling with the reference toxicology center. The patient was also treated with activated charcoal and magnesium sulphate, intravenous fluids and pantoprazole. Four days later she was discharged as asymptomatic, with normal sinus rhythm. Emergency physicians should be aware of this type of poisoning, especially in cases with typical ECG alterations in patients not treated with digoxin and medical history of plants ingestion. Cardio-active glycosides are present in different plants, often used inappropriately, with potential toxic effects and harmful drug interactions.

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Published
2016-10-28
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Issue
Section
Case Reports
Keywords:
Plant poisoning, Nerium oleander, Cardiac glycosides, Digoxin antibodies FAB fragments, Cardiac dysrhythmia
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How to Cite
Tampieri, A., Mucci, F., Palmonari, V., Giovannini, E., Lenzi, T., & Cenni, P. (2016). Severe symptomatic bradycardia after a dinner of spicy oleander soup. Emergency Care Journal, 12(2). https://doi.org/10.4081/ecj.2016.6252