Oleander poisoning: treatment with digoxin-specific Fab antibody fragments

Ann Emerg Med. 1988 Jul;17(7):732-5. doi: 10.1016/s0196-0644(88)80625-5.


A 37-year-old man presented two hours after the ingestion of "a handful" of oleander leaves (probably Nerium oleander) in a suicide attempt. Cardiotoxicity was evidenced by the presence of bradycardia (rate, 30 to 45) with sinoatrial nodal arrest and junctional escape consistent with a cardiac glycoside effect. The patient was treated empirically with a single dose of five vials (200 mg) of digoxin-specific Fab antibody fragments (Digibind). The pretreatment digoxin level was 1.5 ng/mL. After treatment, the patient's rhythm stabilized with residual sinus bradycardia (rate, 56). The patient recovered uneventfully and was discharged on the fifth hospital day to inpatient psychiatric care.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Bradycardia / chemically induced
  • Bradycardia / therapy
  • Cardiac Glycosides / poisoning
  • Digoxin / blood
  • Digoxin / immunology*
  • Electrocardiography
  • Humans
  • Immunoglobulin Fab Fragments / administration & dosage
  • Immunoglobulin Fab Fragments / therapeutic use*
  • Male
  • Plant Poisoning / therapy*
  • Suicide, Attempted


  • Cardiac Glycosides
  • Immunoglobulin Fab Fragments
  • digoxin antibodies Fab fragments
  • Digoxin