Clinical Practice and Cases in Emergency Medicine

Introduction: The “lucky nut” is the seed of the yellow oleander plant, often sold as a medicinal supplement in unregulated markets and known to contain cardiac glycosides, which may cause life- threatening bradycardias and Digoxin-like toxicity upon ingestion. Diagnosis is typically clinical, with treatment including Digoxin immune Fab with supportive intensive cardiac care. 

Case Report: A 70-year-old male presented to the emergency department after ingesting one-fourth of a Peruvian nut he found at a local market to reduce his nocturnal polyuria. The patient brought a part of the Peruvian nut with him, which was identified as a seed of the yellow oleander. His clinical presentation was consistent with a digoxin-like toxicity, requiring multiple vials of Digoxin immune Fab and admission to the cardiac intensive care unit. 

Conclusion: Yellow oleander can cause a cardiac glycoside-related cardiotoxicity similar to a digoxin-like toxicity. Digoxin-like toxicity should be considered in the bradycardic patient with a recent ingestion of a plant or seed. It is important to obtain a thorough history including medication reconciliation and supplement use. Despite well-documented dangers, yellow oleander continues to appear as an unregulated ingredient or contaminant in dietary supplements. This case highlights the severity of oleander toxicity, the challenge of managing digoxin-like cardiac glycoside poisoning, and the public health risk posed by unintentional ingestion of supplements containing yellow oleander.