Işıl BAVUNOĞLU, Zeynep TURKMEN, Musa MALTA

Oleander Poisoning as an Example of Self-Medication Attempt

Background: There is an increasing interest in herbal products as a self-medication method in recent years. Some plant extracts either turn into drugs over time or are consumed directly without treatment. One of these plants is Nerium oleander L., which is a potentially lethal plant, since it has cardiac glycosides. However, numerous researches of its extracts have been per-formed against cancer cell lines in recent literature. This contradiction leads to misinterpretation and in-duces the prevalence of intoxication or fatal cases.Case Report: This case is associated with an olean-der-poisoned patient, who was admitted to the Emer-gency unit 20 hours after the first dose, and 8 hours after the second dose. Although she lives in a metrop-olis and has a higher level of educationand numerous hospital facilities available, she had decided to take self-medication for her Hashimoto's thyroiditis and malignant thyroid disease which was caused by her apprehensive thoughts. Oleandrin was detected in the urine at a concentration of 3.2 ng/mL and in the serum at a concentration of 8.4 ng/mL by chromatographic analysis at the time of admission.Conclusion: This case represents the misunderstand-ing of herbal treatments by the community. Promoting awareness of the potential toxicity of this plant among the public may help to reduce the incidence of poison-ing due to Nerium species

PDF

___

Türkmen Z, Türkdoğru S, Mercan S, Açıkkol M. Forensic and legal aspect of the contents of herbal and supplementary prod- ucts. Bull Leg Med 2014;19:38-48. [CrossRef]
Newman RA, Kondo Y, Yokoyama T, Dixon S, Cartwright C, Chan D, et al. Autophagic cell death of human pancreatic tumor cells mediated by oleandrin, a lipid-soluble cardiac glycoside. Integr Cancer Ther 2007;6:354-64. [CrossRef]
Bandara V, Weinstein SA, White J, Eddleston M. A review of the natural history, toxinology, diagnosis and clinical management of Nerium oleander (common oleander) and Thevetiaperuviana (yel- low oleander) poisoning. Toxicon 2010;56:273-81. [CrossRef]
Saravanapavananthan N, Ganeshamoorthy J. Yellow oleander poisoning-a study of 170 cases. Forensic Sci Int 1988;36:247- 50. [CrossRef]
Wasfi IA, Zorob O, Alkatheeri NA, Alawadhi AM. A fatal case of oleandrin poisoning. Forensic Sci Int 2008;179:31-6. [CrossRef]
Pietsch J, Oertel R, Trautmann S, Schulz K, Kopp B, DreBler J. A non-fatal oleander poisoning. Int J Leg Med 2005;119:236-40. [CrossRef]
Dasgupta A, Risin SA, Reyes M, Actor JK. Rapid detection of oleander poisoning by Digoxin III, a new Digoxin assay: impact on serum Digoxin measurement. Am J Clin Pathol 2008;129:548-53. [CrossRef]
Praveen US, Yogaraje GCV, Gowtham MD, Nayak VG, Mohan BM, Rapid detection of residues of cardenolides of Nerium ole- ander (linn.) by High Performance Thin Layer Chromatography (HPTLC) in autopsied samples. International Symposium for Thin Layer Chromatography HPTLC 2006, Berlin, 9-11October 2006.
Turkmen Z, Mercan S, Cengiz S. An HPTLC method for the determination of Oleandrin in Nerium Plant Extracts and Its Ap- plication to Forensic Toxicology. J Planar Chromatogr - Mod TLC 2013;26:279-283.
Vallé B, Lairez O, Gandia P, Rouge D, Franchitto N. Circuitous diagnosis in concealed self-poisoning with Nerium oleander. Clin Toxicol 2012;50:228-9. [CrossRef]