A young woman is admitted after ingesting a large quantity of yellow oleander (Thevetia peruviana) seeds. She has vomiting, sinus bradycardia, AV block and peaked T waves. After decontamination, the most appropriate definitive therapy for severe cardiac glycoside poisoning in this setting is:

• A Calcium gluconate infusion
• B High-dose insulin euglycaemia therapy
• C Sodium bicarbonate bolus infusion
• D Digoxin-specific antibody Fab fragments ✓

Explanation

Oleandrin and thevetin bind digoxin-specific Fab fragments, so anti-digoxin Fab therapy reverses life-threatening bradyarrhythmias and hyperkalaemia in severe oleander poisoning, and it is accepted as definitive treatment when available. Insulin-glucose is used for beta-blocker overdose, bicarbonate for sodium-channel blockade, and IV calcium is avoided in glycoside toxicity because calcium loading may precipitate fatal arrhythmias. Supportive measures like atropine and temporary pacing remain temporising steps where Fab is unavailable.

Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.