Pirasath Selladurai, Arulnithy Kanagasingam
Consultant Cardiologist, Department of Cardiology, Teaching Hospital, Batticaloa, Sri Lanka.
Indian J Med Sci. 2013 Jul-Aug;67(7-8):178-83.
Cardiac toxicity after self-poisoning from ingestion of yellow oleander seeds is common in Eastern Sri Lanka.
To determine the clinical manifestations, cardiac arrhythmias, electrolytes abnormalities and outcome of management using currently available treatment, Poisoning Unit, Tertiary Care Hospital in Eastern Sri Lanka.
We studied 65 patients [Mean age : 23(± 0.43)yrs], (Male: Female=27:38) with yellow oleander poisoning (YOP) admitted to a Poisoning Unit, Tertiary Care Hospital in Eastern Sri Lanka from January to December 2011.
Most patients are symptomatic who presented with classical symptoms of vomiting, abdominal pain and diarrhea. Cardiac dysrhythmias such as bradycardia or an irregular pulse are the most common findings on examination. Most symptomatic patients had conduction defects affecting the sinus node, the atrioventricular (AV) node, or both. Patients showing cardiac arrhythmias that required transfer for specialised management had significantly higher serum potassium concentrations. Almost all patients were treated with multiple activated charcoal even late presentation. Patients with brad arrhythmias were treated with intravenous boluses of atropine and intravenous infusions of isoprenaline. Temporary cardiac pacing was done for those not responding to drug therapy. There were two deaths (3.07%), both had third-degree heart block. They died even definitive treatment could be instituted. Of the remaining 63 patients, 54 (83.1%) patients required treatment, and 29 were treated with only atropine and/or isoprenaline while one required cardiac pacing in addition. 12 (18.4%) patients had arrhythmias that were considered life threatening (second-degree heart block type II, third-degree heart block and nodal bradycardia). They had good recovery even though they had developed cardiac toxicity.
YOP are common among young females. The cardiac toxicity develops within 24 hrs of ingestion of YO seeds. The risk of toxicity has negative correlation with number of seeds. Most patients have nonspecific symptoms. AV conduction defects are common. Multiple activated charcoals alone were safe and adequate in most cases even late presentation.
在斯里兰卡东部，因误食黄花夹竹桃种子导致自我中毒后的心脏毒性很常见。
确定斯里兰卡东部三级护理医院中毒科使用现有治疗方法治疗黄花夹竹桃中毒的临床表现、心律失常、电解质异常及治疗结果。
我们研究了2011年1月至12月期间收治于斯里兰卡东部三级护理医院中毒科的65例黄花夹竹桃中毒（YOP）患者[平均年龄：23（±0.43）岁]，（男:女 = 27:38）。
大多数患者有症状，表现为呕吐、腹痛和腹泻等典型症状。检查中最常见的发现是心律失常，如心动过缓或脉搏不规则。大多数有症状的患者存在影响窦房结、房室（AV）结或两者的传导缺陷。出现需要转至专科治疗的心律失常的患者血清钾浓度显著更高。几乎所有患者即使就诊较晚也接受了多次活性炭治疗。缓慢性心律失常患者接受了静脉注射阿托品和静脉滴注异丙肾上腺素治疗。对药物治疗无反应的患者进行了临时心脏起搏。有两例死亡（3.07%），均为三度房室传导阻滞。即使在可以开始确定性治疗之前他们就死亡了。其余63例患者中，54例（83.1%）需要治疗，29例仅接受了阿托品和/或异丙肾上腺素治疗，1例还需要心脏起搏。12例（18.4%）患者出现了被认为危及生命的心律失常（二度II型房室传导阻滞、三度房室传导阻滞和结性心动过缓）。尽管他们出现了心脏毒性，但恢复良好。
YOP在年轻女性中很常见。心脏毒性在摄入YO种子后24小时内出现。中毒风险与种子数量呈负相关。大多数患者有非特异性症状。房室传导缺陷很常见。即使就诊较晚，大多数情况下单独使用多次活性炭是安全且足够的。
