Human Deaths Related to Oleander Poisoning: A Review of the Literature.

Abstract

Oleander poisoning, resulting from the ingestion of Nerium oleander or Thevetia peruviana, is a serious toxicological issue in various parts of the world, particularly in regions where these plants grow abundantly and are easily accessible. Oleander contains potent cardiac glycosides, such as oleandrin and thevetin, which exert powerful effects on the cardiovascular system, leading to symptoms ranging from nausea and abdominal pain to severe arrhythmias and sudden cardiac death. This review summarizes the existing literature on the epidemiology, clinical features, pathophysiology, and challenges in treatment management associated with oleander poisoning. While supportive care, gastric decontamination, and the administration of digoxin-specific Fab antibody fragments (Digifab) are essential therapeutic measures, limited access to Digifab, delays in intervention, and insufficient supportive care practices remain significant complicating factors. Particular attention is given to findings from autopsy reports, which provide critical insights into the pathophysiological effects of oleander toxins and help bridge gaps in understanding fatal cases. This review acknowledges key limitations, particularly the scarcity of English-language publications, which restricts input from regions such as southern Asia and the Mediterranean-areas where oleander-related poisoning, especially in cases of intentional self-harm, is more prevalent. Additionally, this review highlights the socio-cultural dimensions of oleander ingestion, often linked to intentional self-poisoning, and emphasizes the need for enhanced preventive measures and public education. Future research efforts should prioritize addressing these gaps through autopsy-based studies and the development of more accessible and effective antidotes, which are essential to mitigate the global health burden of oleander-related mortality.