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Accidental fatal poisoning in a child due to ingestion of Nerium oleander leaf

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Abstract

Nerium oleander is an ornamental plant that belongs to the family Apocynaceae. It contains a cardiac glycoside named oleandrin, which is present in all parts of the oleander plant. Suicidal and medication-related deaths due to Nerium oleander poisoning are not uncommon. However, accidental deaths due to oleander leaf ingestion are most commonly encountered. We are reporting a case of an accidental ingestion of Nerium oleander leaf in a child by mistaking it for a guava leaf. The child presented to the casualty with vomiting, poor sensorium, hypotension, and shock. The child developed hyperkalemia, acute kidney injury, myocardial dysfunction, and bleeding manifestations. The urine output was decreased (< 0.5 ml/kg/h). Later, the child died after 36 h. On autopsy examination, periorbital puffiness and bluish discoloration of the nail beds were present. Petechial hemorrhages were present in the heart, kidney, and mesentery. The stomach mucosa was hemorrhagic. Histopathologically, the lung showed interstitial congestion, the liver showed centrilobular necrosis, and the kidney showed acute tubular necrosis. Toxicology analysis was positive for oleander poisoning. This case highlights the toxic nature of Nerium oleander ingestion and the importance of avoiding such plants around residential areas.

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Authors and Affiliations

  1. Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

    Sathish Ayyappan

  2. Department of Forensic Medicine and Toxicology, Arunai Medical College and Hospital, Tiruvannamalai, Tamil Nadu, India

    Ashok N

  3. Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India

    Pampa Ch Toi

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  1. Sathish Ayyappan
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  2. Ashok N
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  3. Pampa Ch Toi
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All authors contributed to the conception and design of the work, the interpretation of the findings, analysis, drafting of the work, and final review. All authors approved the final version of the manuscript for publication.

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Correspondence to Sathish Ayyappan.

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Ayyappan, S., N, A. & Toi, P.C. Accidental fatal poisoning in a child due to ingestion of Nerium oleander leaf. Forensic Sci Med Pathol (2023). https://doi.org/10.1007/s12024-023-00771-7

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  • DOI: https://doi.org/10.1007/s12024-023-00771-7

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