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

M Eddleston, C A Ariaratnam, W P Meyer, G Perera, A M Kularatne, S Attapattu, M H Sheriff, D A Warrell

Research output: Contribution to journalArticlepeer-review


Deliberate self-harm is an important problem in the developing world. Ingestion of yellow oleander seeds (Thevetia peruviana) has recently become a popular method of self-harm in northern Sri Lanka -- there are now thousands of cases each year. These seeds contain cardiac glycosides that cause vomiting, dizziness, and cardiac dysrhythmias such as conduction block affecting the sinus and AV nodes. This paper reports a study of the condition's mortality and morbidity conducted in 1995 in Anuradhapura General Hospital, a secondary referral centre serving 750 000 people in Sri Lanka's north central province. 415 cases were admitted to the hospital during 11 months; 61% were women and 46% were less than 21 years old. A prospective study of 79 patients showed that 6% died soon after admission. 43% presented with marked cardiac dysrhythmias which necessitated ther transfer to the coronary care unit in Colombo for prophylactic temporary cardiac pacing. The reasons for the acts of self-harm were often relatively trivial, particularly in children; most denied that they wished to die. Unfortunately, the case fatality rate for oleander poisoning in Sri Lanka is at least 10%. This epidemic is not only causing many unnecessary deaths, it is also putting immense stress on the already stretched Sri Lankan health services. There is an urgent need for an intervention which could be used in rural hospitals, thus preventing the hazardous and expensive emergency transfer of patients to the capital.

Original languageEnglish
Pages (from-to)266-73
Number of pages8
JournalTropical Medicine and International Health
Issue number4
Publication statusPublished - Apr 1999


  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Arrhythmias, Cardiac
  • Cardiac Glycosides
  • Child
  • Disease Outbreaks
  • Electrocardiography
  • Female
  • Humans
  • Male
  • Middle Aged
  • Morbidity
  • Plants, Toxic
  • Population Surveillance
  • Prospective Studies
  • Rural Health
  • Seeds
  • Sri Lanka
  • Suicide, Attempted


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