Case Report

J Korean Soc Emerg Med. 2024; 35(1): 89-93.

Published online 2024 February 28.

항 디곡신 특이항체를 이용한 협죽도 중독의 치료

장찬희¹ , 정진우^1,2

Corresponding Author:
Jinwoo Jeong
Tel: 051-240-5590
Fax: 051-240-5309
Email: jinwoo@dau.ac.kr

Received 2023 April 10;    Accepted 2023 July 14.

Nerium indicum is a tree belonging to the order: Gentianales, Family Apocynaceae, which grows mainly on Jeju Island in Korea and is predominantly used as an ornamental plant. The tree contains toxic substances such as oleandrin and adynerin, and of these, oleandrin acts as a potent cardiac glycoside, causing symptoms similar to digoxin poisoning. A 38-year-old male was admitted to the emergency department with symptoms of nausea, vomiting, dizziness, and abdominal pain after ingesting about 1 L of water boiled with oleander that he had collected intending to commit suicide. The electrocardiogram (ECG) showed a 2:1 atrioventricular block with ST-segment depression and T-wave inversion. He was treated with atropine and digoxin-specific antibody fragments (DigiFab). The patient was discharged without any specific complaints or findings except for persistent ST-segment and T-wave abnormalities on the ECG. In cases of poisoning due to Nerium indicum, atropine may be helpful in the management of severe bradycardia. The use of a digoxin-specific antibody as an antidote, even in small doses, followed by additional doses based on the clinical course, may be effective in treating the poisoning.

Keywords : Nerium; Cardiac glycosides; Immunoglobulin Fab fragments; Antidotes