Oleander poisoning: treatment with digoxin-specific Fab antibody fragments

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.