Oleander (Nerium oleander) poisoning mimics digoxin toxicity. In postmortem analysis, how can oleander poisoning be confirmed analytically, and what serum electrolyte abnormality is characteristic?
- A Positive digoxin immunoassay with hyperkalemia — oleandrin cross-reacts with digoxin antibodies ✓
- B Gas chromatography shows aconitine peak with hypokalemia
- C Thin-layer chromatography of gastric contents with hyponatremia
- D HPLC confirms oleandrin; electrolytes show hypocalcemia
Explanation
Oleandrin (the active cardiac glycoside in Nerium oleander) cross-reacts with commercial digoxin immunoassays (FPIA, CLIA, EMIT), producing a falsely elevated 'digoxin' level. This is a well-recognized diagnostic pitfall. Like digoxin, oleandrin inhibits Na+/K+ ATPase, causing intracellular sodium accumulation, calcium overload, and extracellular hyperkalemia (as K+ cannot enter cells). HPLC-MS/MS can definitively identify oleandrin as distinct from digoxin. Aconitine and hypokalemia (B) are associated with Aconitum poisoning. Hyponatremia (C) and hypocalcemia (D) are not characteristic findings in cardiac glycoside toxicity.
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.