Sir, A normal 2-yr-old girl presented with loose motions and vomiting followed by drowsiness. History revealed that the patient had developed these symptoms within 30 min of consumption of a yellow funnel shaped flower. Examination revealed an irregularly irregular heart rate with ST segment elevation on electrocardiogram with intermittent bradycardia. Blood pressure was 60/42 mm Hg in the right arm in supine position and the respiratory rate was 45/min with acidotic breathing. On central nervous system examination, the child was drowsy but arousable. Pupils were bilaterally equal and reacting to light. There was no cranial nerve palsy or focal neurological deficit. Gastric lavage yielded a yellow colored fluid. Activated charcoal was administered after the lavage in the casualty, which was approximately after 45 min of consumption of the flower. The sensorium rapidly deteriorated and patient became comatose. Intravenous fluids and antibiotic coverage was given. Patient had decreased perfusion and hypotension, for which a dopamine drip was started. Bradycardia was treated with intravenous atropine. Elective endotracheal intubation was undertaken and patient was mechanically ventilated. Serum potassium was 7 mmol/dl and an arterial blood gas revealed compensated metabolic acidosis which were treated as per standard guidelines. Later, the child developed an episode of generalized tonic-clonic convulsion for which she required injection midazolam and injection phenytoin intravenously. As signs of II degree heart block were seen on ECG, temporary pacing was planned, but patient developed asystole and did not respond to resuscitative measures. The flower ingested was confirmed by the father as yellow oleander from the photograph in the textbook of toxicology.
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