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Q J Med 1999; 92: 483-485
© 1999 Association of Physicians

Editorial

Management of acute yellow oleander poisoning

M. Eddleston and D.A. Warrell

Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford

In nature, a wide variety of cardiotonic steroids is found in plants, the insects that feed on them and in the parotid glands and skin of some toads (family Bufonidae; genera Bufo, Atelopus, Dendrophryniscus and Melanophryniscus). All these natural drugs contain a steroid nucleus with a lactone ring, five-membered in the case of cardenolides, six-membered in bufadienolides. The cardiac glycosides have a carbohydrate or sugar moiety attached through an oxygen bridge to carbon 3 of the `A' ring of the steroid. The myocardial effects of these compounds are attributable to increased intracellular concentrations of Ca2+ and Na+ resulting from inhibition of the transmembrane Na+/K+ ATPase pump. The digitalis glycosides are by far the best known of the cardiac glycosides, but many hundreds of others have been identified in dozens of different species of plants from at least 12 different families. The Apocyanaceae (dog banes) are sources of African arrow . . . [Full Text of this Article]

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