A fatal case of self-poisoning through the ingestion of oleander leaves

Azzalini, Elena; Bernini, Marzia; Vezzoli, Sara; Antonietti, Anna; Verzeletti, Andrea

doi:10.1016/j.jflm.2019.05.016

Cited by 19 publications

(16 citation statements)

References 9 publications

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“…In humans, mortality due to oleander usually involves the voluntary ingestion of decoctions or portions of the vegetable for suicidal purposes [7]. However, accidental poisonings have been described, particularly in children, where one leaf can be lethal [4,6].…”

Section: Introductionmentioning

confidence: 99%

Outbreak of Oleander (Nerium oleander) Poisoning in Dairy Cattle: Clinical and Food Safety Implications

Ceci

Girolami

Capucchio

et al. 2020

Toxins

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Oleander is a spontaneous shrub widely occurring in Mediterranean regions. Poisoning is sporadically reported in livestock, mainly due to the ingestion of leaves containing toxic cardiac glycosides (primarily oleandrin). In this study, 50 lactating Fleckvieh cows were affected after being offered a diet containing dry oleander pruning wastes accidentally mixed with fodder. Clinical examination, electrocardiogram, and blood sampling were conducted. Dead animals were necropsied, and heart, liver, kidney, spleen, and intestine were submitted to histological investigation. Oleandrin detection was performed through ultra-high performance liquid chromatography-tandem mass spectrometry in blood, serum, liver, heart, milk, and cheese samples. Severe depression, anorexia, ruminal atony, diarrhea, serous nasal discharge, tachycardia, and irregular heartbeat were the most common clinical signs. The first animal died within 48 h, and a total of 13 cows died in 4 days. Disseminated hyperemia and hemorrhages, multifocal coagulative necrosis of the cardiac muscle fibers, and severe and diffuse enteritis were suggestive of oleander poisoning. The diagnosis was confirmed by the presence of oleandrin in serum, liver, heart, milk, and cheese. Our results confirm the high toxicity of oleander in cattle and report for the first time the transfer into milk and dairy products, suggesting a potential risk for the consumers.

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Section: Introductionmentioning

confidence: 99%

Outbreak of Oleander (Nerium oleander) Poisoning in Dairy Cattle: Clinical and Food Safety Implications

Ceci

Girolami

Capucchio

et al. 2020

Toxins

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“…The differences in oleandrin concentration detected in similar samples obtained in various cases, or in different samples, may be closely related to the postmortem process and the time of death (Sosabowski, 2004). The results of reported cases indicated that oleandrin targeted the heart, liver, and brain (shown in Figure 4B); however, there was large interindividual variability (Carfora et al, 2021;Blum and Rieders, 1987;Zhai et al, 2018;Azzalini et al, 2019). The detection results of several biological samples case 3 of Figure 4B showed that the concentration of oleandrin was the highest in the gastric content, followed by stomach wall, bile, liver, and urine; the lowest concentrations were found in the heart and blood (Zhai et al, 2018).…”

Section: Distributionmentioning

confidence: 95%

“…Therefore, oleandrin has received a lot of attention from researchers and is now a primary focus of the pharmaceutical industry. However, oleandrin has a narrow therapeutic window, a complex pharmacokinetics profile, and is prone to inducing poisoning ( Azzalini et al, 2019 ), which can result in arrhythmias, neurological disturbances, and even death. Related pre-clinical and clinical cases of intentional, accidental, and suicidal oleander consumption are frequently reported worldwide ( Arao, 2002 ; Lin and Rong, 2007 ; Kozikowski et al, 2009 ; Al et al, 2010 ; Senthilkumaran et al, 2011 ; Kucukdurmaz et al, 2012 ; Papi et al, 2012 ; Renier et al, 2013 ; Bavunoglu et al, 2016 ; Azzalini et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Oleandrin: A Systematic Review of its Natural Sources, Structural Properties, Detection Methods, Pharmacokinetics and Toxicology

et al. 2022

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Oleandrin is a highly lipid-soluble cardiac glycoside isolated from the plant Nerium oleander (Apocynaceae) and is used as a traditional herbal medicine due to its excellent pharmacological properties. It is widely applied for various disease treatments, such as congestive heart failure. Recently, oleandrin has attracted widespread attention due to its extensive anti-cancer and novel anti-viral effects. However, oleandrin has a narrow therapeutic window and exhibits various toxicities, especially typical cardiotoxicity, which is often fatal. This severe toxicity and low polarity have significantly hindered its application in the clinic. This review describes natural sources, structural properties, and detection methods of oleandrin. Based on reported poisoning cases and sporadic animal experiments, the pharmacokinetic characteristics of oleandrin are summarized, so as to infer some possible phenomena, such as enterohepatic circulation. Moreover, the relevant factors affecting the pharmacokinetics of oleandrin are analyzed, and some research approaches that may ameliorate the pharmacokinetic behavior of oleandrin are proposed. With the toxicology of oleandrin being thoroughly reviewed, the development of safe clinical applications of oleandrin may be possible given potential research strategies to decrease toxicity.

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“…The pathological evaluation indicated petechiae, edema, and congestion in tongue, gastric, and lung. 33 PBI-05204, a N. Oleander extract comprising oleandrin, blocked the "a-3 subunit of Na/K ATPase, FGF-2 export, Akt and p70S6K," leading to alleviating the activity of mTOR. Grade 1 atrioventricular block was observed in 10 subjects and supraventricular tachycardia (grade II) in one patient.…”

Section: Clinical Toxicity Of N Oleandermentioning

confidence: 99%

Toxicity effects of Nerium oleander, basic and clinical evidence: A comprehensive review

et al. 2020

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Introduction: Nerium oleander is a plant that is frequently grown in gardens and public areas. N. oleander is distributed originally in subtropical Asia but is now growing in many parts of the world, such as the United States, Australia, China, and Middle East countries. Pharmacological effects of plant including antinociceptive, anti-inflammatory, and anticancer activity were reported, but the potential toxic effects of all parts of the shrub either fresh or dried on animal and human body were documented. Method: The data of this review article were obtained from Medline/Pubmed, Scopusand Google Scholar databases in English until September 2019. To include all publications in this field, keywords such as N. oleander and toxicity were used. Results: The poisoning effects of plant or their active alkaloids induced infiltration of cells with hemorrhage and sever negative changes in the lung, induce lesions, and infiltration of inflammatory cells into the portal spaces with scattered necrosis of hepatocytes in the liver, cardiac toxicity of the plant in the heart were included, induced varying degrees of hemorrhage, myocardial degeneration, and necrosis. It also induced arrhythmia, sinus bradycardia, and prolonged P-R interval in electrocardiographic records. Conclusions: The toxic effects of N. oleander are mostly related to its inhibitory effects on the Na+-K+ ATPase pump in the cellular membrane. However, the exact molecular mechanism involved in the toxicity of N. oleander is not clear.

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A fatal case of self-poisoning through the ingestion of oleander leaves

Cited by 19 publications

References 9 publications

Outbreak of Oleander (Nerium oleander) Poisoning in Dairy Cattle: Clinical and Food Safety Implications

Outbreak of Oleander (Nerium oleander) Poisoning in Dairy Cattle: Clinical and Food Safety Implications

Oleandrin: A Systematic Review of its Natural Sources, Structural Properties, Detection Methods, Pharmacokinetics and Toxicology

Toxicity effects of Nerium oleander, basic and clinical evidence: A comprehensive review

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