Ramesh, B (2015) Analysis of clinical, biochemical profile and cardiac arrhythmias and outcome in patients with acute yellow oleander poisoning in a tertiary care hospital. Masters thesis, Madras Medical College, Chennai.
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Abstract
Yellow oleander (Thevetia peruviana), is one of the most poisonous plants which contains numerous toxins . Every part of it contains toxins. The toxic effects resemble to that of digitalis toxicity . Most poisonings have a clear guidelines for the effective treatment and its complications. Though the chemical nature of yellow oleander is clearly described , the guidelines for its management has not been defined adequately and requires a larger study. This study was done to find out the incidence of yellow oleander poisoning among admissions in Toxicology unit of a tertiary care hospital , to study the clinical and biochemical aspects, and to find correlation between clinical, biochemical parameters and electrocardiographic changes of yellow oleander poisoning and to assess the risk factors for cardiotoxicity and the outcome and to compare the results of our observation with previous published reports. Methodology: 50 patients admitted in the toxicology unit , Institute of Internal Medicine,Rajiv Gandhi Government General Hospital , Chennai with a history of yellow oleander ingestion were selected. Selected sociodemographic, clinical, biochemical, electrocardiographic and treatment details were collected from the patients and recorded in a proforma. Data regarding poisoning comprised of part ingested, quantity of poison, method of ingestion, whether consumption in empty stomach or after food, time of ingestion, first aid at home, consumption to admission interval, treatment given, duration of hospital stay and the type of outcome. Results: In our study, out of 50 patients, 6 patients (12%) were <20 years, 27 patients (54%) were in the age group of 21-30 years, 12 patients (24%) were in the age group of 31-40 years, and 5 patients (10%) were above 40 years of age. Out of 50 patients, 22 (44%) were males, and 28 (56%) were females. Most of the patients presented with vomiting ( 80% ) , giddiness (68.6 %),Palpitation (48.6%), abdominal pain (42.9%), breathlessness (34.3%).Only 2 patients who was very sick on admission presented with altered sensorium (5.7%) . Most of the patients in our study presented with sinus bradycardia 25(50%). 11 of patients (22%) presented with 1°AV block. 2 patients(4%) presented with 2°AV block. ST changes were seen in 2 patients (4%). 2 patients (4%) who presented late presented with CHB. In our study, most of the patients had consumed 3-5 seeds (64%). In our study mortality was seen in patients who have taken more than 8 seeds. In 19 patients (38%) the first aid was initiated within 2 hours . In 25 patients (50%) the first aid was initiated between 2 to 6 hours. In 6 patients (12%) first aid was more than 4 hours. Chisquare test revealed p value of 0.08 which was significant. Conclusion: Yellow oleander poisoning was most commonly observed among young adults and adolescents. Although there was a slight female preponderance the difference was not statistically significant.In majority of cases, the intention was suicidal secondary to interpersonal conflict, grief reaction, situational reaction, unemployment etc. The most common symptoms of yellow oleander poisoning in the present study were vomiting, giddiness and diarrhea.Electrocardiographic changes noted in the present study were mainly due to depressed conduction. Most common abnormalities were sinus bradycardia, ST & T changes similar to digoxin effect / toxicity, first degree AV block, third degree AV block and sino-atrial block. Hyperkalemia as a manifestation of yellow oleander poisoning was uncommon in the present study compared to Srilankan studies.There was a positive correlation between incidence of cardiotoxicity as the quantity of seeds ingested. There was a higher incidence of cardiotoxicity in those who had taken the seeds /fruits crushed when compared to those who had chewed or swallowed the poison. The occurrence of cardiotoxicity was higher in patients who had vomiting, diarrhea or altered mental status compared to patients who did not have any of these symptoms.The mean serum potassium values at presentation were normal in patients who had cardiotoxicity when compared to patients who had no cardiotoxicity.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Yellow oleander; Cardiotoxicity; Arrhythmia; Hyperkalemia |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Punitha K |
| Date Deposited: | 07 Aug 2017 12:07 |
| Last Modified: | 09 Aug 2017 03:11 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2522 |
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