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 ............
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.
Strychinine seeds
Abrus precatorius
Yellow oleander seeds
Ricinus communis seeds
Toxicology