Epidemic of self-poisoning with seeds of the yellow oleander tree (Thevetia peruviana) in northern Sri Lanka

Deliberate self-harm is an important problem in the developing world. Inges tion of yellow oleander seeds (Thevetia peruviana) has recently become a po pular method of self-harm in northern Sri Lanka - there are now thousands o f cases each year. These seeds contain cardiac glycosides that cause vomiti ng, dizziness, and cardiac dysrhythmias such as conduction block affecting the sinus and AV nodes. This paper reports a study of the condition's morta lity and morbidity conducted in 1995 in Anuradhapura General Hospital, a se condary referral centre serving 750 000 people in Sri Lanka's north central province. 415 cases were admitted to the hospital during 11 months; 61% we re women and 46% were less than 21 years old. A prospective study of 79 pat ients showed that 6% died soon after admission. 43% presented with marked c ardiac dysrhythmias which necessitated their transfer to the corollary care unit in Colombo for prophylactic temporary cardiac pacing. The reasons for the acts of self-harm were often relatively trivial, particularly in child ren; most denied that they wished to die. Unfortunately the case fatality r ate for oleander poisoning in Sri Lanka is at least 10%. This epidemic is n ot only causing many unnecessary deaths, it is also putting immense stress on the already stretched Sri Lankan health services. There is an urgent nee d for an intervention which could be used in rural hospitals, thus preventi ng the hazardous and expensive emergency transfer of patients to the capita l.