Poisoning with seeds of Cerbera manghas (sea mango) or Thevetia peruviana (yellow oleander) mimics which toxidrome?

• A Cholinergic crisis — salivation, lacrimation, miosis, bradycardia, bronchospasm
• B Serotonin syndrome — hyperthermia, clonus, agitation, diaphoresis
• C Opioid toxicity — miosis, respiratory depression, hypotension
• D Cardiac glycoside toxicity — bradyarrhythmias, AV block, hyperkalaemia ✓

Explanation

Thevetia peruviana (peeli kaner) contains thevetin A, thevetin B, and neriifolin — potent cardiac glycosides. Like digoxin and oleandrin, they inhibit Na+/K+-ATPase, causing bradyarrhythmias, AV block, ventricular ectopics, hyperkalaemia, and nausea/vomiting. The 20-minute whole-blood clotting test (WBCT-20) remains normal (unlike viper envenomation). Anti-digoxin Fab fragments (DigiFab) are the antidote. Thevetia is a common suicidal poison in South and Southeast Asia and Sri Lanka.

Reference: The Essentials of Forensic Medicine and Toxicology (Narayan Reddy), 34th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.