Fatal poisoning by ingestion of a self-prepared oleander leaf infusion

Abstract

An unusual case of poisoning by the ingestion of oleander leaves is reported. A 71 year old male laboratory technician committed suicide at home in this unusual manner. At the death scene a steel pan and other paraphernalia, used for the extraction of oleandrin and other cardiac glycosides from the leaves of the Nerium oleander plant were found.Toxicological investigations for oleandrin, oleandrigenin, neritaloside, and odoroside were performed by LC–MS/MS on all biological samples (peripheral blood, vitreous humor, urine, liver, gastric contents) and on the yellow infusion found at the death scene.In all samples, toxic levels of oleandrin were detected (blood 37.5 ng/mL, vitreous humor 12.6 ng/mL, urine 83.8 ng/mL, liver 205 ng/mg, gastric content 31.2 µg/mL, infusion 38.5 µg/mL). Qualitative results for oleandrigenin, neritaloside, and odoroside were obtained. Oleandrigenin was present in all tissue samples whereas neritaloside and odoroside were absent in the blood and vitreous humor but present in urine, liver, gastric content, and in the leaf brew.The purpose of this study was the identification of oleandrin and its congener oleandrigenin, detected in the vitreous humor. The blood/vitreous humor ratio was also calculated in order to assess of the likely time interval from ingestion to death. According to the toxicological results death was attributed to fatal arrhythmia due to oleander intoxication. The manner of death was classified as suicide through the ingestion of the infusion.

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

“…Oleandrin concentrations have been assessed in various biological samples, including the heart, bile, peripheral blood, urine, liver, and gastric content, where the LC-MS/MS detection limit reached 0.01 ng/ml. In addition, liquid-liquid extraction or solid-phase extraction was the most common pretreatment method, exhibiting the advantages of simplicity and ideal extraction recovery rate ( Tor et al, 2005 ; Wasfi et al, 2008 ; Zhai et al, 2018 ; Malysheva et al, 2020 ; Carfora et al, 2021 ). These factors make this sensitive and specific method a powerful tool for toxicology and toxicokinetics studies in humans and livestock, and may provide key information to clinicians and veterinary practitioners regarding oleandrin toxicity.…”

“…However, oleandrin is currently the only constituent isolated from oleander that is available as a pure standard ( Tor et al, 2005 ). Other toxic components of oleander, such as neritaloside, oleandrigenin, and odoroside standards are not available commercially, and only LC/QqTOF or Orbitrap MS have been applied for their preliminary qualitative assessments in some studies ( Wang et al, 2000 ; Carfora et al, 2021 ). The identification of all the metabolites of oleandrin and other toxic components of oleander is also of great significance for the study of oleander pharmacology.…”

“…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).…”

Pharmacological Activity Review on Selected Indian Traditional Medicinal Plants

“…Carfora A et al [30] reported poisoning of oleander leaf infusion. A laboratory technician committed suicide by consuming oleander leaf infusion.…”

Detection of Highly Poisonous Nerium oleander Using Quantitative Real-Time PCR with Specific Primers

“…According to the investigation of 150 plant-poisoning reports in South India, oleander was suggested as the prime culprit in 65% of poisoning cases [9]. A large number of poisoning cases were also reported in the Mediterranean, where oleander is widely distributed [10][11][12]. In addition to events of human poisoning, numerous cases have also been reported in livestock due to Toxins 2022, 14, 776 2 of 10 accidental ingestion in the wild and unplanned contamination of N. oleander in feed [13][14][15][16].…”