Asia Pacific Journal of Medical Toxicology

Association of poisoning severity score with clinical outcomes in yellow oleander poisoning – a hospital-based observational study

Document Type : Original Article

Authors

Shakti Bansal 1
Manoj Kumar Mohanty 2
Sindhu Sudha Sahu 3
Satyabrata Guru 4

1 Senior Resident, Department of Forensic Medicine and Toxicology, A.I.I.M.S., Rishikesh, Uttarakhand, India

2 Professor and Head, Department of Forensic Medicine and Toxicology, A.I.I.M.S, Bhubaneswar, Odisha, India

3 Associate Professor, Department of Forensic Medicine and Toxicology, A.I.I.M.S., Bhubaneswar, Odisha, India

4 Associate Professor, Department of Trauma and Emergency Medicine, A.I.I.M.S., Bhubaneswar, Odisha, India

https://doi.org/10.22038/apjmt.2026.93956.1554
Abstract
Background:: Acute poisoning is a major cause of preventable morbidity and mortality. In India, plant poisoning accounts for 6-15% of poisoning cases, with yellow oleander (Thevetia peruviana) among the most common toxic plants. Despite its clinical importance, evidence regarding severity assessment and prognostic factors remains limited. The Poisoning Severity Score (PSS) is an internationally accepted tool for grading poisoning severity, but it has rarely been evaluated for Yellow Oleander Poisoning (YOP) in India.
Methods: This prospective observational study assessed a modified Poisoning Severity Score in patients with YOP and evaluated its association with clinical outcomes. The modified PSS was recorded at admission, and patients were classified into grades 0-4 based on the most severe clinical signs and symptoms. Patients were followed until discharge or death.
Results: YOP accounted for 8.68% of all poisoning cases during the study period, with a case fatality proportion of 5.7%. Among 53 patients, the mean age was 30 years, and 64.2% were female. Most poisonings were intentional (88.7%), and ingestion of crushed seeds was the commonest mode of exposure (49.0%). Moderate poisoning (PSS Grade 2) was observed in 49.1% of patients. PSS grade showed significant associations with age, quantity of poison ingested, serum potassium level, duration of hospitalisation, and clinical outcome (all p<0.05). Overall, 88.7% of patients recovered, whereas all deaths occurred among patients with higher PSS grades.
Conclusion: The modified PSS is a useful tool for early assessment of severity and prognostication in Yellow Oleander Poisoning, supporting timely risk stratification and appropriate clinical management.

Keywords

Poisoning Severity Score (PSS)
Yellow Oleander
Electrocardiogram (ECG)
Morbidity and Mortality Association
Outcome
Subjects
1.      Nadeem MN, Maqdoom M, Akif ME. A Prospective Observational Study on Pattern of Poisoning Cases Reported to Emergency Department of a Teaching Hospital in South India. Biomed Pharmacol J. 2020 Dec 31;13(4):1863–9.
2.      World Health Organization. World health statistics 2024: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2024. 42-45.
3.      Nelson LS, Goldfrank LR. Plants. In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, editors. Goldfrank’s Toxicologic Emergencies [Internet]. 11th ed. New York, NY: McGraw-Hill Education; 2019
4.      Langford SD, Boor PJ. Oleander toxicity: an examination of human and animal toxic exposures. Toxicology. 1996;109(1):1-13.
5.      Bandara V, Weinstein SA, White J, Eddleston M. A review of the natural history, toxicology, diagnosis and clinical management of Nerium oleander (common oleander) and Thevetia peruviana (yellow oleander) poisoning. Toxicon. 2010;56(3):273-81.
6.      Renier AC, Kass PH, Magdesian KG, Madigan JE, Aleman M, Pusterla N. Oleander toxicosis in equids: 30 cases (1995–2010). Journal of the American Veterinary Medical Association. 2013;242(4):540-9.
7.      Rafi M, Kumar PG, Jaber MM. A Study on Incidence, Clinical Profile and Outcome of Cardiac Dysrhythmias in Yellow Oleander. Int J Sci Stud 2019;7(1):41-7.
8.      Gopalakrishnan SK, Kandasamy S, Isaac B, Jayasankar C, Chandru C. Oleander toxicity - the clinical spectrum and mortality predictors: an observational study. Internet J Med Update. 2017;12(1):4-8.
9.       Pillay VV, Sasidharan A. Oleander and Datura Poisoning: An Update. Indian J Crit Care Med. 2019 Dec;23(Suppl 4): S250–5. 
10.  Zhang Y, Yu B, Wang N, Li T. Acute poisoning in Shenyang, China: a retrospective and descriptive study from 2012 to 2016. BMJ Open. 2018;8(8): e021881.
11.  Casey PB, Dexter EM, Michell J, Vale JA. The Prospective Value of the IPCS/EC/EAPCCT Poisoning Severity Score in Cases of Poisoning. Journal of Toxicology: Clinical Toxicology. 1998;36(3):215-17.
12.  Persson HE, Sjöberg GK, Haines JA, de Garbino JP. Poisoning Severity Score. Grading of Acute Poisoning. Journal of Toxicology: Clinical Toxicology. 1998 Jan;36(3):205–13.
13.  Sivakumar DK, Nithya G. Study on clinical profile, electrolyte and electrocardiographic abnormalities in patients with yellow oleander poisoning. Int J Adv Med. 2018;5(2):299-306.
14.  Nair SJ, Sujatha C, Chettiar K P S, Sasikala K. Toxico-epidemiology of acute poisoning; an exploratory study from a tertiary care hospital in South India along with global comparisons and solutions. J Forensic Leg Med. 2021; 83:102247.
15.  Mathew R, Jamshed N, Aggarwal P, Patel S, Pandey R. Profile of acute poisoning cases and their outcome in a teaching hospital of north India. J Fam Med Prim Care. 2019;8(12):3935.
16.  Eddleston M, Ariaratnam C A, Sjöström L, Jayalath S, Rajakanthan K, Rajapakse S, et al. Acute yellow oleander (Thevetia peruviana) poisoning: cardiac arrhythmias, electrolyte disturbances, and serum cardiac glycoside concentrations on presentation to hospital. Heart (British Cardiac Society). 2000;83(3): 301–306.
17.  Karthik G, Iyadurai R, Ralph R, Prakash V, Abhilash KP, Sathyendra S, et al. Acute oleander poisoning: A study of the clinical profile from a tertiary care centre in South India. J Family Med Prim Care. 2020;9(1):136-40.
18.  Mandal L. Yellow Oleander-Thevetia peruviana poisoning. Postgrad Med J NAMS. 2012; 12(2):52-55.
19.  Gouthaman Chinnathambi Somanathan. A study of clinical profile of yellow oleander poisoning. International Journal of Current Research. 2020;12(11):14652-14654.
20.  Bose TK, Basu RK, Biswas B, De JN, Majumdar BC, Datta S, et al. Cardiovascular effects of yellow oleander ingestion. J Ind Med Assoc 1999; 97:407-10.
21.  Fonseka MM, Seneviratne SL, de Silva CE, Gunatilake SB, de Silva HJ. Yellow oleander poisoning in Sri Lanka: outcome in a secondary care hospital. Hum Exp Toxicol. 2002;21(6):293-5.
22.  Papi L, Luciani AB, Forni D, Giusiani M. Unexpected double lethal oleander poisoning. Am J Forensic Med Pathol. 2012 Mar;33(1):93-7
23.  Sam KG, Kondabolu K, Pati D, Kamath A, Pradeep Kumar G, Rao PG. Poisoning severity score, APACHE II and GCS: effective clinical indices for estimating severity and predicting outcome of acute organophosphorus and carbamate poisoning. J Forensic Leg Med. 2009;16(5):239-247.
24.  Pirasath S, Arulnithy K. Yellow oleander poisoning in the eastern province: An analysis of admission and outcome. Indian J Med Sci. 2013;67(7):178.
25.  Bandyopadhyay TK, Pathak A. Acute yellow oleander poisoning-its cardiotoxicity and clinical profile: a study on Eastern India population. Indian J Forensic Med Toxicol. 2023;17(1):85-91.
26.  Thomas VV, Newbigging N, Johnson J, Kalimuthu M, Gunasekaran K, Iyadurai R. Review of current evidence in management of oleander poisoning. Curr Med Issues 2022; 20:82-88.
27. Eriyawa A, Jayamanne S, Lokunarangoda N, Pathmeswaran A, Francis R, Arulnithy K, et al. Incidence of electrocardiographic and electrolyte changes in acute oleander poisoning in humans: A systematic review and meta-analysis protocol. PLoS One. 2025;20(3):e0320301.
 
Asia Pacific Journal of Medical Toxicology
Volume 15, Issue 2
Spring 2026
Pages 53-62

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