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J Korean Soc Emerg Med > Volume 35(1); 2024 > Article
Journal of The Korean Society of Emergency Medicine 2024;35(1): 89-93.
항 디곡신 특이항체를 이용한 협죽도 중독의 치료
장찬희1 , 정진우1,2
1동아대학교의료원 응급의학과
2동아대학교 의과대학 응급의학교실
Treatment of Nerium indicum poisoning with digoxin-specific antibody fragments
Chanhee Jang1 , Jinwoo Jeong1,2
1Department of Emergency Medicine, Dong-A University Medical Center, Busan, Korea
2Department of Emergency Medicine, Dong-A University College of Medicine, Busan, Korea
Correspondence  Jinwoo Jeong ,Tel: 051-240-5590, Fax: 051-240-5309, Email: jinwoo@dau.ac.kr,
Received: April 10, 2023; Revised: July 13, 2023   Accepted: July 14, 2023.  Published online: February 28, 2024.
ABSTRACT
Nerium indicum is a tree belonging to the order: Gentianales, Family Apocynaceae, which grows mainly on Jeju Island in Korea and is predominantly used as an ornamental plant. The tree contains toxic substances such as oleandrin and adynerin, and of these, oleandrin acts as a potent cardiac glycoside, causing symptoms similar to digoxin poisoning. A 38-year-old male was admitted to the emergency department with symptoms of nausea, vomiting, dizziness, and abdominal pain after ingesting about 1 L of water boiled with oleander that he had collected intending to commit suicide. The electrocardiogram (ECG) showed a 2:1 atrioventricular block with ST-segment depression and T-wave inversion. He was treated with atropine and digoxin-specific antibody fragments (DigiFab). The patient was discharged without any specific complaints or findings except for persistent ST-segment and T-wave abnormalities on the ECG. In cases of poisoning due to Nerium indicum, atropine may be helpful in the management of severe bradycardia. The use of a digoxin-specific antibody as an antidote, even in small doses, followed by additional doses based on the clinical course, may be effective in treating the poisoning.
Key words: Nerium; Cardiac glycosides; Immunoglobulin Fab fragments; Antidotes
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