Management overview for cardiac glycoside poisoning from plants

There are a number of cardiac glycoside–containing plants in Australia, including foxglove (Digitalis purpurea), yellow oleander (Cascabala thevetia), common oleander (Nerium species; pink, red, white or apricot oleander), and desert rose (Adenium obesum) (see Common plant-derived toxins for common plant-derived toxins).

Poisoning from cardiac glycoside–containing plants causes similar toxicity as poisoning from digoxin tablets. All plant parts are considered toxic; however, seeds usually contain more glycoside than other plant parts. Serum digoxin concentration does not accurately quantify the exposure to plant-derived cardiac glycosides.

Urgently contact a clinical toxicologist or poisons information centre (13 11 26) if cardiac glycoside poisoning from plants is suspected. Management is time critical. The mainstays of therapy are gastrointestinal decontamination with activated charcoal, resuscitation, electrocardiographic monitoring and antidotal therapy with digoxin-specific immune antibody fragments (digoxin immune Fab). All patients who present with deliberate self-poisoning from plants require psychiatric assessment before discharge.