• 1.

    Burrows GE, Tyrl RJ. Toxic plants of North America. Ames, Iowa: Blackwell Publishing, 2001;6869, 7882, 8889.

  • 2.

    Aslani MR, Vovassaghi AR, Mohri M, et al. Clinical and pathological aspects of experimental oleander (Nerium oleander) toxicosis in sheep. Vet Res Commun 2004;28:609616.

    • Search Google Scholar
    • Export Citation
  • 3.

    Barbosa RR, Fontenele-Neto JD, Soto-Blanco B. Toxicity in goats caused by oleander (Nerium oleander). Res Vet Sci 2008;85:279281.

  • 4.

    Galey FD, Holstege DM, Konstanze HP, et al. Diagnosis of oleander poisoning in livestock. J Vet Diagn Invest 1996;8:358364.

  • 5.

    Langford SD, Boor PJ. Oleander toxicity: an examination of human and animal toxic exposures. Toxicology 1996;109:113.

  • 6.

    Oryan A, Maham M, Rezakhani A, et al. Morphological studies on experimental oleander poisoning in cattle. Zentralbl Veterinarmed [A] 1996;43:625634.

    • Search Google Scholar
    • Export Citation
  • 7.

    Galey FD, Holstege DM, Johnson BJ, et al. Toxicity and diagnosis of oleander (Nerium oleander) poisoning in livestock. In: Garland T, Barr AC, eds. Toxic plants and other natural toxicants. York, England: CAB International, 1998.

    • Search Google Scholar
    • Export Citation
  • 8.

    Tor ER, Filigenzi MS, Puschner B. Determination of oleandrin in tissues and biological fluids by liquid chromatography-electrospray tandem mass spectrometry. J Agric Food Chem 2005;53:43224325.

    • Search Google Scholar
    • Export Citation
  • 9.

    Fowler ME. Medicine and surgery of South American camelids: llama, alpaca, vicuňa, guanaco. 2nd ed. Ames, Iowa: Iowa State University Press, 1998;7172, 507509.

    • Search Google Scholar
    • Export Citation
  • 10.

    Ada SE, Al-Yahya MA, Farhan AH. Acute toxicity of various oral doses of dried Nerium oleander leaves in sheep. Am J Chin Med 2001;29:525532.

    • Search Google Scholar
    • Export Citation
  • 11.

    Hughes KJ, Dart AJ, Hodgson DR. Suspected Nerium oleander (Oleander) poisoning in a horse. Aust Vet J 2002;80:412415.

  • 12.

    Smith PA, Aldridge BM, Kittleson MD. Oleander toxicosis in a donkey. J Vet Intern Med 2003;17:111114.

  • 13.

    Samal KK, Sahu HK, Kar MK, et al. Yellow oleander (Cerbera thevetia) poisoning with jaundice and renal failure. J Assoc Physicians India 1989;37:232233.

    • Search Google Scholar
    • Export Citation
  • 14.

    Eddleston M, Ariaratnam CA, Sjostrom L, et al. Acute yellow oleander (Thevetia peruviana) poisoning: cardiac arrhythmias, electrolyte disturbances, and serum cardiac glycoside concentrations on presentation to hospital. Heart 2000;83:301306.

    • Search Google Scholar
    • Export Citation
  • 15.

    Kelly RA, Smith TW. Pharmacological treatment of heart failure. In: Gilman AG, Rall TW, Nies AS, et al, eds. Goodman and Gilman's the pharmacological basis of therapeutics. 9th ed. New York: Pergman Press, 1996;810821.

    • Search Google Scholar
    • Export Citation
  • 16.

    Oji O, Okafor QE. Toxicological studies on stem bark, leaf and seed kernel of yellow oleander (Thevetia peruviana). Phytother Res 2000;14:133135.

    • Search Google Scholar
    • Export Citation
  • 17.

    Zia A, Siddiqui SB, Begum S, et al. Studies on the constituents of the leaves of Nerium oleander on behavior pattern in mice. J Ethnopharmacol 1995;49:3339.

    • Search Google Scholar
    • Export Citation
  • 18.

    Liu J, Periyasamy SM, Gunning W, et al. Effects of cardiac glycosides on sodium pump expression and function in LLC-PK1 and MDCK cells. Kidney Int 2002;62:21182125.

    • Search Google Scholar
    • Export Citation
  • 19.

    Shaw D, Pearn J. Oleander poisoning. Med J Aust 1979;2:267269.

  • 20.

    De Silva HA, Fonseka MMD, Pathmeswaran A, et al. Multipledose activated charcoal for treatment of yellow oleander poisoning: a single-blind, randomized, placebo-controlled trial. Lancet 2003;361:19351938.

    • Search Google Scholar
    • Export Citation
  • 21.

    Ni D, Madden TL, Johansen M, et al. Murine pharmacokinetics and metabolism of oleandrin, a cytotoxic component of Nerium oleander. J Exp Ther Oncol 2002;2:278285.

    • Search Google Scholar
    • Export Citation
  • 22.

    Dasgupta A, Cao S, Wells A. Activated charcoal is effective, but equilibrium dialysis is ineffective in removing oleander leaf extract and oleandrin from human serum: monitoring the effect by measuring apparent digoxin concentration. Ther Drug Monit 2003;25:323330.

    • Search Google Scholar
    • Export Citation
  • 23.

    Tiwary AK, Poppenga RH, Puschner B. In vitro study of the effectiveness of three commercial adsorbents for binding oleander toxins. Clin Toxicol (Phila) 2009;47:213218.

    • Search Google Scholar
    • Export Citation
  • 24.

    Roberts DM, Buckley NA. Antidotes for acute cardenolide (cardiac glycoside) poisoning. Cochrane Database Syst Rev 2006;4:CD005490.

  • 25.

    Camphausen C, Haas NA, Mattke AC. Successful treatment of oleander intoxication (cardiac glycosides) with digoxin-specific Fab antibody fragments in a 7-year-old child: case report and review of literature. Z Kardiol 2005;94:817823.

    • Search Google Scholar
    • Export Citation
  • 26.

    Clark RF, Selden BS, Curry SC. Digoxin-specific Fab fragments in the treatment of oleander toxicity in a canine model. Ann Emerg Med 1991;20:10731077.

    • Search Google Scholar
    • Export Citation
  • 27.

    Chillet P, Korach JM, Petipas D, et al. Digoxin poisoning and anuric acute renal failure: efficiency of the treatment associating digoxin-specific antibodies (Fab) and plasma exchanges. Int J Artif Organs 2002;25:538541.

    • Search Google Scholar
    • Export Citation
  • 28.

    Zdunek M, Mitra A, Mokrzycki MH. Plasma exchange for the removal of digoxin-specific antibody fragments in renal failure; timing is important for maximizing clearance. Am J Kidney Dis 2000;36:177183.

    • Search Google Scholar
    • Export Citation

Advertisement

Oleander intoxication in New World camelids: 12 cases (1995–2006)

Tania A. Kozikowski DVM, DACVIM1, K. Gary Magdesian DVM, DACVIM, DACVECC, DACVCP2, and Birgit Puschner DVM, PhD, DABVT3
View More View Less
  • 1 Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616.
  • | 2 Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA 95616.
  • | 3 California Animal Health and Food Safety Laboratory, School of Veterinary Medicine, University of California, Davis, CA 95616.

Abstract

Objective—To characterize the clinical and clinicopathologic effects and evaluate outcome associated with oleander toxicosis in New World camelids.

Design—Retrospective case series.

Animals—11 llamas and 1 alpaca.

Procedures—Medical records from a veterinary medical teaching hospital from January 1, 1995, to December 31, 2006, were reviewed. Records of all New World camelids that had detectable amounts of oleandrin in samples of serum, urine, or gastrointestinal fluid were included in the study. Descriptive statistics were used to evaluate the history, physical examination findings, clinicopathologic data, and outcome of affected camelids.

Results—11 llamas and 1 alpaca met the inclusion criteria of the study. Either oleander plants were present where the camelids resided (n = 7) or oleander plant material was identified in the hay fed to the camelids (5). One llama was dead on arrival at the hospital, and another was euthanized upon admission because of financial concerns. Of the 10 treated camelids, 9 had evidence of acute renal failure, 7 had gastrointestinal signs, and 4 had cardiac dysrhythmias on initial evaluation. The overall mortality rate was 25%, but the mortality rate for the 10 camelids that were medically treated was 10%.

Conclusions and Clinical Relevance—In New World camelids, oleander intoxication was associated with a triad of clinical effects (ie, renal, gastrointestinal, and cardiovascular dysfunction). Oleander intoxication often represented a herd problem but carried a fair to good prognosis if treated promptly. Oleander toxicosis should be considered a differential diagnosis in sick camelids.

Abstract

Objective—To characterize the clinical and clinicopathologic effects and evaluate outcome associated with oleander toxicosis in New World camelids.

Design—Retrospective case series.

Animals—11 llamas and 1 alpaca.

Procedures—Medical records from a veterinary medical teaching hospital from January 1, 1995, to December 31, 2006, were reviewed. Records of all New World camelids that had detectable amounts of oleandrin in samples of serum, urine, or gastrointestinal fluid were included in the study. Descriptive statistics were used to evaluate the history, physical examination findings, clinicopathologic data, and outcome of affected camelids.

Results—11 llamas and 1 alpaca met the inclusion criteria of the study. Either oleander plants were present where the camelids resided (n = 7) or oleander plant material was identified in the hay fed to the camelids (5). One llama was dead on arrival at the hospital, and another was euthanized upon admission because of financial concerns. Of the 10 treated camelids, 9 had evidence of acute renal failure, 7 had gastrointestinal signs, and 4 had cardiac dysrhythmias on initial evaluation. The overall mortality rate was 25%, but the mortality rate for the 10 camelids that were medically treated was 10%.

Conclusions and Clinical Relevance—In New World camelids, oleander intoxication was associated with a triad of clinical effects (ie, renal, gastrointestinal, and cardiovascular dysfunction). Oleander intoxication often represented a herd problem but carried a fair to good prognosis if treated promptly. Oleander toxicosis should be considered a differential diagnosis in sick camelids.

Contributor Notes

Address correspondence to Dr. Magdesian.