A Study of Cardiac Dysrrythmias in Oleander Seed Poisoning

INTRODUCTION : In developing countries, the hospital admissions due to suicidal attempts are relatively high. Even in western countries mortality due to suicidal attempt is on the rise. The factors influencing suicidal attempts mainly depends on cultural &ethnic background. It is essential to prevent or decrease the number of deaths due to suicidal attempts. In India the incidence of suicidal attempts is more in females. This may be attributed to gender discrimination, lower educational standards, Lack of financial & social independence. Various methods of suicidal attempts used are hanging, drowning, ingestion of chemicals, corrosives or indigenous plant substances. Drug abuse or over dosage also contributes. Among the indigenous plants Oleander is more commonly used. There are two types of oleander: i) Yellow Oleander -Cerebra thevetia, ii) White Oleandar - Nerium odorum. AIM OF STUDY : 1. To determine the incidence of oleander seed poisoning among hospital admissions in Govt. Royapettah hospital from April 2004 - August 2004. 2. To elucidate the factors influencing the incidence of oleander seed poisoning, a) Age, b) Sex, c) Education, d) Socio economic status. 3. To analyze various factors influencing mortality in oleander seed Poisoning: a) Variety of oleander, b) Part of the plant consumed, c) Amount consumed, d) Mode of consumption, e) Time window, f) Cardiac Dysrrythmias. MATERIALS AND METHODS : 100 patients of Yellow Oleander poisoning have been selected randomly in intensive medical care unit in our hospital from April 2004 to August 2004. 1. Detailed history was taken: a. Regarding the number of seeds consumed, b. Reason for consumption, c. Mode of intake– swallowed or chewed or grounded or paste form, d. Time of consumption– whether taken with empty stomach or after food, if taken after food {how many hours}, e. Whether yellow oleander seed is taken alone or with other poisons like organophosphorus, cow dung powder, alcohol or coffee, f. Symptoms at the time of presentation, g. Time between ingestion and admission, h. History of first aid. 2. Complete clinical examination : G/E: Pulse Rate, Rhythm; Blood pressure; Respiratory Rate; Single Breath Count. CVS: JVP(Cannon a waves); Varying intensity of first heart sound; regularity of heart sounds. CNS: GCS, Pupil size& reactions; Neuromuscular weakness; Respiratory muscle paralysis. 3. ECG : Recordings were taken in 12 lead ECG immediately after admission. Patients with arrhythmias were put on continuous ECG monitoring and recordings were taken in lead 2 long strip. Then ECG was repeated 12 hrs later and every 24 hrs till discharge. CONCLUSION : 1. Common age group of poisoning in our study is 15 – 25 yrs. 2. Study reveals a little higher incidence of poisoning in females. 3. yellow oleander is consumed commonly. 4. Oleander seed is the most common part of the plant that is consumed. 5. Mortality is related to time window, no: of seeds consumed, mode of consumption and cardiotoxicity. 6. Most common mode of consumption was in the grounded form 7. In our study mortality is seen more commonly if the consumption of seed was > 3. 8. ECG abnormality is seen in 78 % of the patients. 9. There is a marginal increase in the ECG abnormality in females. 10. ECG abnormality can occur as early as 2 hrs and as late as 18hrs. 11.Commonest arrythmia found in our study is sinus bradycardia. 12. Varying arrythmias observed in the same patient mandates continuous ECG monitoring. 13. ECG abnormality lasted for 4 days in majority of patients which emphasises that monitoring should be done for a minimum of 4 days. 14.Prognosis is good if first aid is given at the earliest & time window < 6 hrs