A-10-year old girl was admitted in ER with history of ingesting 10 crushed seeds of a plant, she couldn't recall how much she had and her ECG looks like this (Figure). Probable cause is ............
Strychinine seeds
Abrus precatorius
Yellow oleander seeds
Ricinus communis seeds
Ans: (c) Yellow oleander seedsRef: VV Pillai, Modern Medical Toxicology, 4th edition, Page 344ECG is diagnostic of 2:1 AV block which is seen in case of Cerbera thevetia poisoning.Yellow oleander (Cerbera thevetia)A cardiac poisonAll parts - poisonousActive principles - Glycosides - Thevetin + thevotoxin = cardiac poison and Cerberin = acts like strychnine Sign and SymptomsGIT - Burning sensation in mouth with tingling of tongue, nausea, vomiting, diarrheaCVS - Rapid, weak pulse, low BP, heart block, collapse and death to peripheral circulatory failure TreatmentSodium molar lactate transfusion with glucose and 1 mg atropine, 2 cc adrenaline and 2 mg noradrenaline (Bisht Regimen)TriviaBisht Regimen is named by Dr. D B Bisht, Former Principal of JIPMER who advocated its use in Cerbera poisoning. So numerous times, questions have come from this topic in JIPMER exams. Must know topic for JIPMER aspirants.
Toxicology