Oleander poisoning

Definition

Oleander poisoning occurs when someone eats the flowers or chews the leaves or stems of the oleander plant (Nerium oleander), or its relative, the yellow oleander (Cascabela thevetia).

This article is for information only. DO NOT use it to treat or manage an actual poison exposure. If you or someone you are with has an exposure, call the local emergency number (such as 911), or the local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.

Alternative Names

Rosebay poisoning; Yellow oleander poisoning; Thevetia peruviana poisoning

Poisonous Ingredient

Poisonous ingredients include:

• Digitoxigenin
• Neriin
• Oleandrin
• Oleondroside

Note: This list may not include all poisonous ingredients.

Where Found

The poisonous substances are found in all parts of the oleander plant:

• Flowers
• Leaves
• Stems
• Twigs

Symptoms

Oleander poisoning can affect many parts of the body.

HEART AND BLOOD

• Irregular or slow heartbeat
• Low blood pressure
• Weakness

EYES, EARS, NOSE, MOUTH, AND THROAT

• Blurred vision
• Vision disturbances, including halos around objects

STOMACH AND INTESTINES

• Diarrhea
• Loss of appetite
• Nausea and vomiting
• Stomach pain

NERVOUS SYSTEM

• Confusion
• Death
• Depression
• Disorientation
• Dizziness
• Drowsiness
• Fainting
• Headache
• Lethargy

SKIN

• Hives
• Rash

Note: Depression, loss of appetite, and halos are most often seen in chronic overdose cases.

Home Care

Seek immediate medical help. DO NOT make a person throw up unless told to do so by poison control or a health care provider.

Before Calling Emergency

Get the following information:

• Person's age, weight, and condition
• Name and part of the plant swallowed, if known
• Time it was swallowed
• Amount swallowed

Poison Control

Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does not need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

What to Expect at the Emergency Room

The provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. The person may receive:

• Activated charcoal
• Blood and urine tests
• Breathing support, including oxygen through a tube through the mouth into the lungs, and a breathing machine (ventilator)
• Chest x-ray
• ECG (electrocardiogram, or heart tracing)
• Fluids through a vein (IV)
• Medicines to treat symptoms including an antidote to reverse the effects of the poison
• Tube through the mouth into the stomach to wash out the stomach (gastric lavage)

Outlook (Prognosis)

How well you do depends on the amount of poison swallowed and how quickly treatment is received. The faster you get medical help, the better the chance for recovery.

Symptoms last for 1 to 3 days and may require a hospital stay. Death is unlikely.

DO NOT touch or eat any plant with which you are not familiar. Wash your hands after working in the garden or walking in the woods.

References

Graeme KA. Toxic plant ingestions. In: Auerbach PS, Cushing TA, Harris NS, eds. Auerbach's Wilderness Medicine. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 65.

Mofenson HC, Caraccio TR, McGuigan M, Greensher J. Medical toxicology. In: Kellerman RD, Rakel DP, eds. Conn's Current Therapy 2022. Philadelphia, PA: Elsevier 2022: 1372-1425.