Oleander (Nerium oleander) poisoning mimics which other class of toxin in its clinical presentation and ECG findings?
- A Cardiac glycoside (digoxin) toxicity — bradyarrhythmias, heart block, ventricular ectopics, hyperkalemia ✓
- B Organophosphate poisoning — bradycardia with SLUD features
- C Tricyclic antidepressant poisoning — QRS widening with sodium channel blockade
- D Beta-blocker overdose — pure sinus bradycardia with preserved QRS
Correct answer: A. Cardiac glycoside (digoxin) toxicity — bradyarrhythmias, heart block, ventricular ectopics, hyperkalemia
Explanation
Oleandrin and neriine in Nerium oleander are cardiac glycosides that inhibit Na+/K+-ATPase, identical in mechanism to digoxin. Clinical features include nausea, vomiting, bradycardia, varying degrees of AV block, ventricular ectopics, bidirectional VT, and hyperkalemia from Na+/K+-ATPase inhibition. The treatment is digoxin-specific Fab antibody fragments (Digifab/Digibind), which also work for oleander toxicity. ECG findings overlap exactly with digoxin toxicity.
Reference: The Essentials of Forensic Medicine and Toxicology (Narayan Reddy), 34th ed.
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