Abstract
Background
Candlenuts (Aleurites moluccana) and yellow oleander seeds (Thevetia peruviana) bear a physical resemblance to one another. Candlenuts are benign and marketed as
weight loss supplements. Yellow oleander seeds, however, contain toxic cardioactive
steroids; as few as 2 seeds may cause fatal poisoning. Because of their physical similarities,
the potential for a lethal substitution exists.
Case Report
A 63-year-old woman presented to the emergency department with vomiting after ingesting
5 of what she believed to be candlenuts that were ordered online under the colloquial
name “Nuez de la India” for the purpose of weight loss. She was bradycardic (nadir
pulse of 30 beats/min) and hyperkalemic (serum potassium 7.3 mEq/L). Within hours
of presentation she suffered a ventricular fibrillation arrest, followed by a terminal
asystolic arrest. Postmortem analyses of liver tissue and the seeds were consistent
with fatal T. peruviana poisoning.
Why Should an Emergency Physician Be Aware of This?
T. peruviana seeds contain toxic cardioactive steroids; their physical resemblance to candlenuts
poses a risk of potentially fatal substitution. Therapy with high-dose digoxin specific
immune fragments (20–30 vials) may be helpful.
Keywords
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References
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Article info
Publication history
Published online: September 08, 2020
Accepted:
July 11,
2020
Received in revised form:
June 23,
2020
Received:
February 11,
2020
Footnotes
Reprints are not available from the authors.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
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