Epidemic of self‐poisoning with seeds of the yellow oleander tree (Thevetia peruviana) in northern Sri Lanka

Abstract

Deliberate self-harm is an important problem in the developing world. Ingestion of yellow oleander seeds (Thevetia peruviana) has recently become a popular method of self-harm in northern Sri Lanka -- there are now thousands of cases each year. These seeds contain cardiac glycosides that cause vomiting, dizziness, and cardiac dysrhythmias such as conduction block affecting the sinus and AV nodes. This paper reports a study of the condition's mortality and morbidity conducted in 1995 in Anuradhapura General Hospital, a secondary referral centre serving 750 000 people in Sri Lanka's north central province. 415 cases were admitted to the hospital during 11 months; 61% were women and 46% were less than 21 years old. A prospective study of 79 patients showed that 6% died soon after admission. 43% presented with marked cardiac dysrhythmias which necessitated ther transfer to the coronary care unit in Colombo for prophylactic temporary cardiac pacing. The reasons for the acts of self-harm were often relatively trivial, particularly in children; most denied that they wished to die. Unfortunately, the case fatality rate for oleander poisoning in Sri Lanka is at least 10%. This epidemic is not only causing many unnecessary deaths, it is also putting immense stress on the already stretched Sri Lankan health services. There is an urgent need for an intervention which could be used in rural hospitals, thus preventing the hazardous and expensive emergency transfer of patients to the capital.

Potential of seed dusts of Jatropha curcas L., Thevetia peruviana (Pers.), and Piper guineense Schumach. against the maize weevil, Sitophilus zeamais (Motschulsky, 1855) (Coleoptera: Curculionidae) in storage of corn grain

“…Studies on the insecticidal activity of Jatropha curcas have been reported by HABOU et al (2011). The use of Thevetia peruviana fruits for suicide attempts has been reported in Sri Lanka and southern India (EDDLESTON et al 1999). KHANAM et al (2008) tested Sapium indicum WILLD., Thevetia neriifolia JUSS.…”

Study on clinical profile, electrolyte and electrocardiographic abnormalities in patients with yellow oleander poisoning

“…Eddleston et al in their observation reported that out of 1939 cases admitted males were 1021 (52.7%). 6 In this study, 76% patients consumed crushed seeds, 22% patients consumed whole seeds, 2% patients consumed leaves and none consumed fruit. So crushed seeds consumption were more common in our study.…”

“…Patients usually presents with hyperkalemia. 6 In this study authors tried to find the presence of various arrhythmias and its association with duration and form of exposure of yellow oleander. Since hyperkalemia is a usual manifestation in yellow oleander poisoning, authors attempted to find association between serum potassium, calcium and magnesium levels and the arrhythmias in yellow oleander poisoning in this study.…”

Suicide and the ‘Poison Complex’: Toxic Relationalities, Child Development, and the Sri Lankan Self-Harm Epidemic

“…From the 1960s, increases in the suicide rate were driven by pesticides poisoning and, since the 1980s, by kanēru (yellow oleander) seed poisoning (De Silva et al 2012;Eddleston, Sheriff, & Hawton 1998;Eddleston et al 1999;Eddleston & Phillips 2004). Correspondingly, decreases in the suicide rate were achieved following restrictions placed on the import and sale of WHO Class 1 toxicity pesticides in 1995 and endosulfans in 1998, as well as improved medical treatment for pesticide and kanēru poisoning (Gunnell et al 2007;Roberts et al 2003).…”