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Kovačević T, Polić B, Ardalić TĆ, Petrović D, Stričević L, Rogulj M, Markić J. A suicide attempt by ingestion of oleander leaves and treatment with digoxin-specific Fab antibody fragments. Arh Hig Rada Toksikol 2023; 74:292-295. [PMID: 38146758 PMCID: PMC10750315 DOI: 10.2478/aiht-2023-74-3752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/01/2023] [Accepted: 12/01/2023] [Indexed: 12/27/2023] Open
Abstract
Natural cardiac glycosides have positive inotropic heart effects but at high, toxic doses they can cause life-threatening cardiac arrhythmias. Here we present the first Croatian case of a 16-year-old girl who attempted suicide by eating dried oleander leaves, which contain natural cardiac glycosides, and her treatment with a specific antidote. The girl presented with an oedema of the uvula indicating local toxicity, severe bradycardia, first-degree atrioventricular block, drowsiness, and vomiting. Having taken her medical history, we started treatment with atropine, intravenous infusion of dextrose-saline solution and gastroprotection, but it was not successful. Then we introduced digoxin-specific Fab antibody fragments and within two hours, the patient's sinus rhythm returned to normal. Cases of self-poisoning with this oleander are common in South-East Asia, because it is often used as a medicinal herb, and digoxin-specific Fab fragments have already been reported as effective antidote against oleander poisoning there. Our case has taught us that it is important to have this drug in the hospital pharmacy both for digitalis and oleander poisoning.
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Affiliation(s)
- Tanja Kovačević
- University Hospital of Split, Department of Paediatrics, Split, Croatia
- University of Split School of Medicine, Split, Croatia
| | - Branka Polić
- University Hospital of Split, Department of Paediatrics, Split, Croatia
- University of Split School of Medicine, Split, Croatia
| | - Tatjana Ćatipović Ardalić
- University Hospital of Split, Department of Paediatrics, Split, Croatia
- University of Split School of Medicine, Split, Croatia
| | - Davor Petrović
- University Hospital of Split, Department of Paediatrics, Split, Croatia
- University of Split School of Medicine, Split, Croatia
| | - Luka Stričević
- University Hospital of Split, Department of Paediatrics, Split, Croatia
- University of Split School of Medicine, Split, Croatia
| | - Maja Rogulj
- University Hospital of Split, Department of Psychiatry, Split, Croatia
| | - Joško Markić
- University Hospital of Split, Department of Paediatrics, Split, Croatia
- University of Split School of Medicine, Split, Croatia
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Carfora A, Petrella R, Borriello R, Aventaggiato L, Gagliano-Candela R, Campobasso CP. Fatal poisoning by ingestion of a self-prepared oleander leaf infusion. Forensic Sci Med Pathol 2020; 17:120-125. [PMID: 33237522 PMCID: PMC7889672 DOI: 10.1007/s12024-020-00338-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 11/26/2022]
Abstract
An unusual case of poisoning by the ingestion of oleander leaves is reported. A 71 year old male laboratory technician committed suicide at home in this unusual manner. At the death scene a steel pan and other paraphernalia, used for the extraction of oleandrin and other cardiac glycosides from the leaves of the Nerium oleander plant were found.Toxicological investigations for oleandrin, oleandrigenin, neritaloside, and odoroside were performed by LC-MS/MS on all biological samples (peripheral blood, vitreous humor, urine, liver, gastric contents) and on the yellow infusion found at the death scene.In all samples, toxic levels of oleandrin were detected (blood 37.5 ng/mL, vitreous humor 12.6 ng/mL, urine 83.8 ng/mL, liver 205 ng/mg, gastric content 31.2 µg/mL, infusion 38.5 µg/mL). Qualitative results for oleandrigenin, neritaloside, and odoroside were obtained. Oleandrigenin was present in all tissue samples whereas neritaloside and odoroside were absent in the blood and vitreous humor but present in urine, liver, gastric content, and in the leaf brew.The purpose of this study was the identification of oleandrin and its congener oleandrigenin, detected in the vitreous humor. The blood/vitreous humor ratio was also calculated in order to assess of the likely time interval from ingestion to death. According to the toxicological results death was attributed to fatal arrhythmia due to oleander intoxication. The manner of death was classified as suicide through the ingestion of the infusion.
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Affiliation(s)
- Anna Carfora
- Department of Experimental Medicine, Forensic Toxicology Unit, University of Campania “L. Vanvitelli”, Via L. Armanni, 5, 80138 Napoli, Italy
| | - Raffaella Petrella
- Department of Experimental Medicine, Forensic Toxicology Unit, University of Campania “L. Vanvitelli”, Via L. Armanni, 5, 80138 Napoli, Italy
| | - Renata Borriello
- Department of Experimental Medicine, Forensic Toxicology Unit, University of Campania “L. Vanvitelli”, Via L. Armanni, 5, 80138 Napoli, Italy
| | - Lucia Aventaggiato
- Department Interdisciplinary of Medicine (DIM), Forensic Toxicology Laboratory, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Roberto Gagliano-Candela
- Department Interdisciplinary of Medicine (DIM), Forensic Toxicology Laboratory, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Carlo Pietro Campobasso
- Department of Experimental Medicine, Forensic Toxicology Unit, University of Campania “L. Vanvitelli”, Via L. Armanni, 5, 80138 Napoli, Italy
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López-Alonso M, Miranda M. Copper Supplementation, A Challenge in Cattle. Animals (Basel) 2020; 10:ani10101890. [PMID: 33076570 PMCID: PMC7602799 DOI: 10.3390/ani10101890] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/23/2020] [Accepted: 10/09/2020] [Indexed: 12/16/2022] Open
Abstract
Ensuring adequate copper supplementation in ruminants is a challenging task due to the complexity of copper metabolism in these animals. The three-way interaction between copper, molybdenum and sulphur (Cu-Mo-S) in the rumen makes ruminants, particularly cattle, very susceptible to suffering from secondary copper deficiency. Paradoxically, excessive copper storage in the liver to prevent deficiency becomes a hazard when ruminants are fed copper-supplemented diets even slightly above requirements. While cattle were traditionally thought to be relatively tolerant of copper accumulation, and reports of copper poisoning were until recently somewhat rare, in recent years an increased number of episodes/outbreaks of copper toxicity in cattle, particularly in dairy cattle, have been reported worldwide. The growing number of lethal cases reported seems to indicate that copper intoxication is spreading silently in dairy herds, urging the development of strategies to monitor herd copper status and improve farmers' awareness of copper toxicity. In fact, monitoring studies carried out on numerous samples collected from culled animals in slaughterhouses and/or diagnostic laboratories have demonstrated that large numbers of animals have hepatic copper concentrations well above adequate levels in many different countries. These trends are undoubtedly due to copper supplementation aimed at preventing copper deficiency, as dietary copper intake from pasture alone is unlikely to cause such high levels of accumulation in liver tissue. The reasons behind the copper overfeeding in cattle are related both to a poor understanding of copper metabolism and the theory of "if adding a little produces a response, then adding a lot will produce a better response". Contrary to most trace elements, copper in ruminants has narrow margins of safety, which must also be formulated considering the concentrations of copper antagonists in the diet. This review paper aims to provide nutritionists/veterinary practitioners with the key points about copper metabolism in cattle to guarantee an adequate copper supply while preventing excessive hepatic copper loading, which requires à la carte copper supplementation for each herd.
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Affiliation(s)
- Marta López-Alonso
- Department of Animal Pathology, Faculty of Veterinary Medicine, Universidade de Santiago de Compostela, Campus Terra, 27002 Lugo, Spain;
| | - Marta Miranda
- Department of Anatomy, Animal Production and Clinical Veterinary Sciences, Faculty of Veterinary Medicine, Universidade de Santiago de Compostela, Campus Terra, 27002 Lugo, Spain
- Correspondence: ; Tel.: +34-982-822-615
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Ceci L, Girolami F, Capucchio MT, Colombino E, Nebbia C, Gosetti F, Marengo E, Iarussi F, Carelli G. Outbreak of Oleander ( Nerium oleander) Poisoning in Dairy Cattle: Clinical and Food Safety Implications. Toxins (Basel) 2020; 12:toxins12080471. [PMID: 32722138 PMCID: PMC7472096 DOI: 10.3390/toxins12080471] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/16/2022] Open
Abstract
Oleander is a spontaneous shrub widely occurring in Mediterranean regions. Poisoning is sporadically reported in livestock, mainly due to the ingestion of leaves containing toxic cardiac glycosides (primarily oleandrin). In this study, 50 lactating Fleckvieh cows were affected after being offered a diet containing dry oleander pruning wastes accidentally mixed with fodder. Clinical examination, electrocardiogram, and blood sampling were conducted. Dead animals were necropsied, and heart, liver, kidney, spleen, and intestine were submitted to histological investigation. Oleandrin detection was performed through ultra-high performance liquid chromatography-tandem mass spectrometry in blood, serum, liver, heart, milk, and cheese samples. Severe depression, anorexia, ruminal atony, diarrhea, serous nasal discharge, tachycardia, and irregular heartbeat were the most common clinical signs. The first animal died within 48 h, and a total of 13 cows died in 4 days. Disseminated hyperemia and hemorrhages, multifocal coagulative necrosis of the cardiac muscle fibers, and severe and diffuse enteritis were suggestive of oleander poisoning. The diagnosis was confirmed by the presence of oleandrin in serum, liver, heart, milk, and cheese. Our results confirm the high toxicity of oleander in cattle and report for the first time the transfer into milk and dairy products, suggesting a potential risk for the consumers.
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Affiliation(s)
- Luigi Ceci
- Department of Veterinary Medicine, University of Bari, 70121 Bari, Italy; (L.C.); (G.C.)
| | - Flavia Girolami
- Department of Veterinary Sciences, University of Torino, 10124 Torino, Italy; (M.T.C.); (E.C.); (C.N.)
- Correspondence:
| | - Maria Teresa Capucchio
- Department of Veterinary Sciences, University of Torino, 10124 Torino, Italy; (M.T.C.); (E.C.); (C.N.)
| | - Elena Colombino
- Department of Veterinary Sciences, University of Torino, 10124 Torino, Italy; (M.T.C.); (E.C.); (C.N.)
| | - Carlo Nebbia
- Department of Veterinary Sciences, University of Torino, 10124 Torino, Italy; (M.T.C.); (E.C.); (C.N.)
| | - Fabio Gosetti
- Department of Earth and Environmental Sciences, University of Milano-Bicocca, 20126 Milano, Italy;
| | - Emilio Marengo
- Department of Sciences and Technological Innovation, University of Eastern Piedmont, 13100 Vercelli, Italy;
| | - Fabrizio Iarussi
- Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy;
| | - Grazia Carelli
- Department of Veterinary Medicine, University of Bari, 70121 Bari, Italy; (L.C.); (G.C.)
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Cowan V, Blakley B. Acute lead poisoning in western Canadian cattle - A 16-year retrospective study of diagnostic case records. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2016; 57:421-426. [PMID: 27041761 PMCID: PMC4790235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study describes the epidemiology of acute lead poisoning in western Canadian cattle over the 16-year period of 1998 to 2013 and reports background bovine tissue lead concentrations. Case records from Prairie Diagnostic Services, Western College of Veterinary Medicine, identified 525 cases of acute lead toxicity over the investigational period. Poisonings were influenced by year (P < 0.0001) and month (P < 0.0001). Submissions were highest in 2009 (15.6%), 2001 (11.2%), and 2006 (9.9%). Most cases were observed during May, June, and July (62.3%). Cattle 6 months of age and younger were frequently poisoned (53.5%; P < 0.0001). Beef breeds were predominantly poisoned. Mean toxic lead concentrations (mg/kg wet weight) in the blood, liver, and kidney were 1.30 ± 1.70 (n = 301), 33.5 ± 80.5 (n = 172), and 56.3 ± 39.7 (n = 61). Mean normal lead concentrations in the blood, liver, and kidney were 0.036 ± 0.003 mg/kg (n= 1081), 0.16 ± 0.63 mg/kg (n = 382), and 0.41 ± 0.62 mg/kg (n = 64).
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Affiliation(s)
| | - Barry Blakley
- Address all correspondence to Dr. Barry Blakley; e-mail:
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Roegner A, Giannitti F, Woods LW, Mete A, Puschner B. Public health implications of lead poisoning in backyard chickens and cattle: four cases. VETERINARY MEDICINE-RESEARCH AND REPORTS 2013; 4:11-20. [PMID: 32670839 PMCID: PMC7337163 DOI: 10.2147/vmrr.s36083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 04/23/2013] [Indexed: 11/30/2022]
Abstract
Lead intoxication in livestock has historically been associated with cattle turned out to pasture and accidental ingestion of lead from drinking crankcase oil, licking grease from machinery, chewing on plumbing or batteries, or drinking water contaminated from leaching materials. Even with the decrease in manufactured items produced with lead, contaminants persist in the landscape and may enter the food supply through animal products. Changing patterns of open range herds moving to new pasture and the increased popularity of urban/suburban backyard chickens or other livestock necessitates public awareness about the clinical signs of lead intoxication, the potential for subclinical animals, public health concerns, particularly for exposure in children, and testing options available. Cases of lead intoxication in livestock demand a thorough case work-up to identify all sources of lead, address subclinical cases, evaluate risk to consumers, and make management suggestions for future prevention. We discuss four recent cases of confirmed lead poisoning in backyard chickens and open range cattle and assess the public health implications therein. Taken as a whole and considering the potential of the remaining herd or flock to be affected without necessarily showing signs, public health officials and veterinarians should be prepared to advise clients on case work-up and management and prevention considerations. Backyard chickens and cattle may not present for suspected lead poisoning as in several of the cases discussed herein yet may still contain concerning tissue or blood levels. The authors believe increased surveillance through heavy metal screens is crucial to adequately protect public health.
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Affiliation(s)
- Amber Roegner
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Federico Giannitti
- California Animal Health and Food Safety Laboratory System, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Leslie W Woods
- California Animal Health and Food Safety Laboratory System, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Aslı Mete
- California Animal Health and Food Safety Laboratory System, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Birgit Puschner
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, CA, USA.,California Animal Health and Food Safety Laboratory System, School of Veterinary Medicine, University of California, Davis, CA, USA
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