Nature's Poison Pill: A Case of Digoxin-Like Toxicity From the Seed of the Ornamental Plant Thevetia peruviana

Thevetia peruviana (yellow oleander) is an ornamental shrub found in tropical and subtropical regions, including tropical America. All parts of the plant are toxic due to cardiac glycosides, which can cause severe cardiotoxicity and arrhythmias. Poisoning is associated with significant mortality, often due to deliberate self-harm. This report describes a case of accidental ingestion of Thevetia peruviana seeds by a patient who believed that they could treat benign prostatic hyperplasia (BPH). The patient presented to the emergency department within 30 minutes of ingesting yellow oleander seeds with nausea, vomiting, and abdominal cramps. Although initial vital signs were stable, he developed sinus bradycardia and symptoms of cardiac glycoside toxicity, including dizziness, tachypnea, and visual disturbances. Lab results later showed a serum digoxin level of 4.04 ng/mL, and the poison control center recommended digoxin immune fab (DigiFab). He received a total of 15 vials intravenously, resulting in marked clinical improvement. He was monitored on continuous telemetry in the cardiac unit and discharged in stable condition after four days. Although DigiFab is not approved by the U.S. Food and Drug Administration for oleander poisoning, it remains the most effective reported antidote, and timely administration is crucial for successful management. Given the limited reports of oleander toxicity in the United States, this case highlights the risks of unregulated herbal remedies and the clinical presentation and management of oleander toxicity, underscoring the need for public education about oleander toxicity and the dangers of unregulated herbal remedies.