{
    "abstract": "Natural cardiac glycosides have positive inotropic heart effects but at high, toxic doses they can cause life-threatening cardiac arrhythmias. Here we present the first Croatian case of a 16-year-old girl who attempted suicide by eating dried oleander leaves, which contain natural cardiac glycosides, and her treatment with a specific antidote. The girl presented with an oedema of the uvula indicating local toxicity, severe bradycardia, first-degree atrioventricular block, drowsiness, and vomiting. Having taken her medical history, we started treatment with atropine, intravenous infusion of dextrose-saline solution and gastroprotection, but it was not successful. Then we introduced digoxin-specific Fab antibody fragments and within two hours, the patient's sinus rhythm returned to normal. Cases of self-poisoning with this oleander are common in South-East Asia, because it is often used as a medicinal herb, and digoxin-specific Fab fragments have already been reported as effective antidote against oleander poisoning there. Our case has taught us that it is important to have this drug in the hospital pharmacy both for digitalis and oleander poisoning.\nPrirodni sr\u010dani glikozidi imaju pozitivan inotropni u\u010dinak na srce. U visokim, toksi\u010dnim dozama mogu prouzro\u010diti za \u017eivot opasne sr\u010dane aritmije. Predstavljamo prvi hrvatski slu\u010daj poku\u0161aja samoubojstva 16-godi\u0161nje djevojke konzumiranjem oleandrovih suhih listova, koji sadr\u017ee prirodne sr\u010dane glikozide, i lije\u010denje specifi\u010dnim protuotrovom. Djevojka je tako\u0111er imala edem uvule kao znak lokalne toksi\u010dnosti. Svi podatci dobiveni su analizom dokumentacije iz medicinskoga kartona. U djevojke se javila zna\u010dajna bradikardija, atrioventrikularni blok prvog stupnja, pospanost i povra\u0107anje. Po\u010detno lije\u010denje atropinom, intravenskom infuzijom fiziolo\u0161ke otopine i 5 % glukoze uz gastroprotekciju nisu bili u\u010dinkoviti. Pacijentica je zatim lije\u010dena digoksin-specifi\u010dnim Fab imunoglobulinskim fragmentima. Unutar dva sata od primjene lijeka sr\u010dani se ritam promijenio u normalni sinusni ritam. Ovo je rijedak slu\u010daj poku\u0161aja suicida samootrovanjem na na\u0161im prostorima. Slu\u010dajevi samootrovanja ovom biljkom \u010desti su u jugoisto\u010dnoj Aziji jer se ondje \u010desto koristi kao biljni proizvod za samolije\u010denje. Digoksin specifi\u010dni Fab fragmenti su protuotrov za predoziranje digoksinom, kao i za akutnu intoksikaciju ovom biljkom. Va\u017eno je imati ovaj lijek u bolni\u010dkoj ljekarni kako za intoksikaciju digitalisom tako i za otrovanje ovom biljkom.",
    "authors": [
        {
            "affiliation": "University Hospital of Split, Department of Paediatrics, Split, Croatia.\nUniversity of Split School of Medicine, Split, Croatia.",
            "firstname": "Tanja",
            "initials": "T",
            "lastname": "Kova\u010devi\u0107"
        },
        {
            "affiliation": "University Hospital of Split, Department of Paediatrics, Split, Croatia.\nUniversity of Split School of Medicine, Split, Croatia.",
            "firstname": "Branka",
            "initials": "B",
            "lastname": "Poli\u0107"
        },
        {
            "affiliation": "University Hospital of Split, Department of Paediatrics, Split, Croatia.\nUniversity of Split School of Medicine, Split, Croatia.",
            "firstname": "Tatjana \u0106atipovi\u0107",
            "initials": "T\u0106",
            "lastname": "Ardali\u0107"
        },
        {
            "affiliation": "University Hospital of Split, Department of Paediatrics, Split, Croatia.\nUniversity of Split School of Medicine, Split, Croatia.",
            "firstname": "Davor",
            "initials": "D",
            "lastname": "Petrovi\u0107"
        },
        {
            "affiliation": "University Hospital of Split, Department of Paediatrics, Split, Croatia.\nUniversity of Split School of Medicine, Split, Croatia.",
            "firstname": "Luka",
            "initials": "L",
            "lastname": "Stri\u010devi\u0107"
        },
        {
            "affiliation": "University Hospital of Split, Department of Psychiatry, Split, Croatia.",
            "firstname": "Maja",
            "initials": "M",
            "lastname": "Rogulj"
        },
        {
            "affiliation": "University Hospital of Split, Department of Paediatrics, Split, Croatia.\nUniversity of Split School of Medicine, Split, Croatia.",
            "firstname": "Jo\u0161ko",
            "initials": "J",
            "lastname": "Marki\u0107"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2023 Tanja Kova\u010devi\u0107 et al., published by Sciendo.\n\u00a9 2023 Tanja Kova\u010devi\u0107 et al., published by Sciendo.",
    "doi": "10.2478/aiht-2023-74-3752\n10.1016/j.toxicon.2010.03.026\n10.1016/j.toxicon.2018.11.429\n10.1038/nrd2682\n10.1001/jama.1982.03320360046030\n10.1016/j.jelectrocard.2010.12.002\n10.5543/tkda.2012.01703\n10.1136/heart.83.3.301\n10.2147/VMRR.S28770\n10.1177/104063879600800314\n10.5694/j.1326-5377.1979.tb127135.x\n10.5152/balkanmedj.2016.150307\n10.1016/0379-0738(88)90150-8\n10.1016/j.forsciint.2008.05.002\n10.1007/s12024-020-00338-w\n10.1080/15563650902824001\n10.1016/s0196-0644(88)80625-5\n10.1046/j.1365-3156.1999.00397.x\n10.1016/j.jflm.2019.05.016\n10.1016/j.tjem.2018.12.002\n10.1007/s00392-005-0293-3\n10.1016/s0140-6736(00)90014-x\n10.1007/s40801-021-00242-x\n10.1097/00007691-200010000-00016",
    "journal": "Arhiv za higijenu rada i toksikologiju",
    "keywords": [
        "Nerium oleander",
        "Thevetia peruviana",
        "antidot",
        "antidotes",
        "common oleander",
        "heart block",
        "oleandrin",
        "oleandrin poisoning",
        "otrovanje",
        "sr\u010dani blok",
        "yellow oleander"
    ],
    "methods": null,
    "publication_date": "2023-12-26",
    "pubmed_id": "38146758\n20438743\n30529380\n18948999\n7038154\n21397908\n22710590\n12217009\n10677410\n30155434\n8844581\n92752\n27761287\n3350448\n18602779\n33237522\n19306191\n3382077\n10357862\n31153008\n31321346\n16382383\n10768435\n33721285\n11034267",
    "results": null,
    "title": "A suicide attempt by ingestion of oleander leaves and treatment with digoxin-specific Fab antibody fragments.",
    "xml": "<Element 'PubmedArticle' at 0x7885030fa980>"
}