International Journal of Legal Medicine

, Volume 119, Issue 4, pp 236–240 | Cite as

A non-fatal oleander poisoning

  • J. Pietsch
  • R. Oertel
  • S. Trautmann
  • K. Schulz
  • B. Kopp
  • J. Dreßler
Case Report

Abstract

The study presents a case of non-fatal poisoning with oleander blooms in a 47-year-old female, with emphasis on the importance of toxicological service in a clinical emergency. After repeated vomiting at home, the patient was admitted at the hospital with cardiac symptoms more than 18 h after the ingestion. Serum samples were assayed immunochemically for digitoxin-related compounds by electrochemiluminescent immunoassay, and using HPLC/MS/MS analysis for oleandrin, the main cardiac glycoside of Nerium oleander. Confirming the non-specific immunoassay results, which are often clinically over-interpreted, oleandrin was detected by HPLC/MS/MS in the serum sample in a concentration of 1.6 ng/ml upon admission. Comparison with previous reports indicates that single compound analysis only permits a toxicological assessment for oleander poisoning and results in the proposal to classify an oleandrin level between 1.0 and 2.0 ng/ml as toxic blood plasma/serum concentration.

Keywords

Nerium oleander Oleandrin Poisoning Immunoassay HPLC/MS/MS 

References

  1. 1.
    Teuscher E, Lindequist U (1994) Biogene Gifte. Gustav Fischer Verlag, StuttgartGoogle Scholar
  2. 2.
    Yamauchi T, Abe F, Tachibana Y, Atal CK, Sharma BM, Imre Z (1983) Quantitative variations in the cardiac glycosides of oleander. Phytochemistry 22:2211–2214CrossRefGoogle Scholar
  3. 3.
    Eddleston M, Warrell DA (1999) Management of acute yellow oleander poisoning. Q J Med 92:483–485Google Scholar
  4. 4.
    Eddleston M, Rajapakse S, Rajakanthan S, Jayalath S, Sjöström L, Santharaj W, Thenabadu PN, Sheriff MHR, Warrell DA (2000) Anti-dioxin Fab fragments in cardiotoxicity induced by ingestion of yellow oleander: a randomised controlled trial. Lancet 355:967–972CrossRefPubMedGoogle Scholar
  5. 5.
    Datta P, Dasgupta A (1997) Interference of oleandrin and oleandrigenin in digitoxin immunoassays: minimal cross reactivity with a new monoclonal chemiluminescent assay and high cross reactivity with the fluorescence polarization assay. Ther Drug Monit 19:465–469CrossRefPubMedGoogle Scholar
  6. 6.
    Dasgupta A, Hart AP (1997) Rapid detection of oleander poisoning using fluorescence polarization immunoassay for digitoxin-effect of treatment with digoxin-specific Fab antibody fragment (ovine). Am J Clin Pathol 108:411–416PubMedGoogle Scholar
  7. 7.
    Jortani SA, Trepanier D, Yatscoff RW, Valdes R (1997) Convergence of three methods to resolve discrepant immunoassay digitoxin results. Clin Chem 43:1805–1808PubMedGoogle Scholar
  8. 8.
    Haynes BE, Bessen HA, Wightman WD (1985) Oleander tea: herbal draught of death. Ann Emerg Med 14:350–353PubMedGoogle Scholar
  9. 9.
    Shumaik GM, Wu AW, Ping AC (1988) Oleander poisoning: treatment with digoxin-specific Fab antibody fragments. Ann Emerg Med 17:732–735PubMedGoogle Scholar
  10. 10.
    Blum LM, Rieders F (1987) Oleandrin distribution in a fatality from rectal and oral Nerium oleander extract administration. J Anal Toxicol 11:219–221PubMedGoogle Scholar
  11. 11.
    Holstege DM, Francis T, Puschner B, Booth MC, Galey FD (2000) Multiresidue screen for cardiotoxins by two-dimensional thin-layer chromatography. J Agric Food Chem 48:60–64CrossRefPubMedGoogle Scholar
  12. 12.
    Tor ER, Holstege DM, Galey FD (1996) Determination of oleander glycosides in biological matrices by high-performance liquid chromatography. J Agric Food Chem 44:2716–2719CrossRefGoogle Scholar
  13. 13.
    Hamada K, Iwamoto A, Miyazaki S, Yamanaka N, Guruge KS (2002) Determination of bovine blood oleandrin by high-performance liquid chromatography and postcolumn derivatization. J Chromatogr Sci 40:515–518PubMedGoogle Scholar
  14. 14.
    Tracqui A, Kintz P, Ludes B, Mangin P (1997) High-performance liquid chromatography ionspray mass spectrometry for the specific determination of digoxin and some related cardiac glycosides in human plasma. J Chromatogr B 692:101–109Google Scholar
  15. 15.
    Tracqui A, Kintz P, Branche F, Ludes B (1998) Confirmation of oleander poisoning by HPLC/MS. Int J Leg Med 111:32–34CrossRefGoogle Scholar
  16. 16.
    Wang XM, Plomley JB, Newman RA, Cisneros A (2000) LC/MS/MS analyses of an oleander extract for cancer treatment. Anal Chem 72:3547–3552CrossRefPubMedGoogle Scholar
  17. 17.
    Arao T, Fuke C, Takaesu H, Nakamoto M, Morinaga Y, Miyazaki T (2002) Simultaneous determination of cardenolides by sonic spray ionisation liquid chromatography-ion trap mass spectrometry—a fatal case of oleander poisoning. J Anal Toxicol 26:222–227PubMedGoogle Scholar
  18. 18.
    Beike J, Frommherz L, Wood M, Brinkmann B, Köhler H (2004) Determination of aconitine in body fluids by LC-MS-MS. Int J Leg Med 118:289–293CrossRefGoogle Scholar
  19. 19.
    Beike J, Karger B, Meiners T, Brinkmann B, Köhler H (2003) LC-MS determination of Taxus alkaloids in biological specimen. Int J Leg Med 117:335–339CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • J. Pietsch
    • 1
  • R. Oertel
    • 2
  • S. Trautmann
    • 3
  • K. Schulz
    • 1
  • B. Kopp
    • 4
  • J. Dreßler
    • 1
  1. 1.Institute of Legal Medicine, Medical Faculty Carl Gustav CarusDresden Technical UniversityDresdenGermany
  2. 2.Institute of Clinical Pharmacology, Medical Faculty Carl Gustav CarusDresden Technical UniversityDresdenGermany
  3. 3.Section of Internal MedicineUniversity Hospital Carl Gustav Carus DresdenDresdenGermany
  4. 4.Institute of Pharmacognosy, Faculty of Natural Sciences and MathematicsUniversity of ViennaViennaAustria

Personalised recommendations