A fatal case of oleandrin poisoning

The study presents a case of fatal poisoning with oleander leaves in an adult diabetic male. After repeated vomiting, and gastrointestinal distress the patient was admitted at the hospital with cardiac symptoms 1 h after the ingestion. Urine samples were assayed immunochemically and by GC–MS for drugs of abuse and for general toxicological screen. Blood was analyzed for alcohol and volatiles by static head space GC–MS. Blood and oleander leaves were analyzed by LC–MS/MS for oleandrin and related compounds, the main cardiac glycosides of Nerium oleander. Oleandrin was detected by LC–MS/MS in the blood sample at a concentration of ∼10 ng/ml. Another cardiac glycoside with pseudo-molecular ion of m/z 577, a likely structural isomer of oleandrin, was also detected in the blood and oleander leaves. However, by using the response as a function of concentration for oleandrin, this cardiac glycoside was roughly estimated at a concentration of ∼10 ng/ml in the deceased blood. This would give a total fatal blood concentration of cardiac glycosides of about ∼20 ng/ml in the deceased blood.