Fatal Yellow Oleander Poisoning From a Weight-Loss Seed Product Requiring Venoarterial Extracorporeal Membrane Oxygenation.

BACKGROUND

Yellow oleander (Cascabela thevetia) seeds marketed as "slimming seeds" in unregulated weight-loss products can cause life-threatening digitalis-like toxicity.

CASE SUMMARY: A 47-year-old woman accidentally ingested approximately 50 yellow oleander seeds sold as a weight-loss supplement. She developed gastrointestinal symptoms, atrial tachyarrhythmias with high-grade atrioventricular block, hyperkalemia, and metabolic acidosis. She received activated charcoal and digoxin immune Fab with transient improvement. Twelve hours later, evolving acute kidney injury led to recurrent refractory ventricular fibrillation. Despite extracorporeal cardiopulmonary resuscitation and venoarterial extracorporeal membrane oxygenation, she died.

DISCUSSION: This case highlights delayed recurrence after a large plant cardiac glycoside ingestion, limitations of total serum digoxin assays after Fab administration, and the risk of catecholaminergic agents precipitating ventricular arrhythmias.

TAKE-HOME MESSAGES: Early digoxin immune Fab guided by electrocardiography and potassium levels-rather than total digoxin levels-is critical. Delayed recurrence should be anticipated with large ingestions and renal impairment.