Deliberate self-poisoning with yellow oleander (Thevetia peruviana) seeds continues to be a major problem in Sri Lanka, especially in rural areas, and results in many deaths annually. The amount of cardioactive toxins absorbed from a seed varies between individuals, and the number of seeds ingested does not always correlate with the degree of toxicity. The treatment of yellow oleander poisoning (YOP) in Sri Lankan hospitals includes gastric lavage, administration of activated charcoal (AC), and intravenous atropine or isoprenaline, or both, for bradyarrhythmias. Temporary cardiac pacing is done if patients develop life-threatening bradyarrythmias; this is often done in a tertiary care hospital. An anti-digoxin antitoxin for YOP was introduced to Sri Lanka in 2001. The antitoxin, antidigoxin antibody Fab fragments, reduces case fatality, but because of cost it is used sparingly.  

doi:10.4038/cmj.v53i2.228  

Ceylon Medical Journal Vol. 53, No. 2, June 2008 pp. 33-35