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Published:
Journal of Analytical Toxicology,
ISSN 0146-4760,
Volume 30, Number 9, November/December 2006,
pp.683-686
Unexpectedly Dangerous Escargot Stew: Oleandrin Poisoning
through the Alimentary Chain
Cecilia Gechtman[1], Federico Guidugli[2], Alessandro Marocchi[1], Adriano
Masarin[1], and Francesco Zoppi[1]
[1]Dipartimento di Medicina di Laboratorio, AO Ospedale Niguarda Cà Granda,
Milano, Italy and
[2]Thermo Electron Corporation, Rodano, Milano, Italy
A female, aged 43 and a male, aged 66, experienced gastrointestinal
and cardiovascular symptoms after a meal including snail stew. Twelve hours
after the ingestion, they presented with nausea, vomiting, diarrhea, and cardiovascular
symptoms typical of acute toxic digoxin ingestion and were hospitalized. The
man’s electrocardiogram was altered, and the woman’s was normal.
Serum digoxin levels, measured on a Roche COBAS Integra 800 with the Roche On-Line
Digoxin reagent, were 1.14 and 1.00 nmol/L, respectively. Potassium levels were
normal in both patients. The serum digoxin concentration decreased on the second
day, and symptoms resolved on the third day with patients fully recovered (i.e.,
reversion to a normal sinus rhythm). Cardiac-glycoside-like intoxication symptoms
follow the ingestion of leaves or flowers of Nerium oleander. The consumed snails
were suspected to be responsible for the intoxication. In the homogenized snail
tissue, the concentration expressed in digoxin equivalents was 0.282 nmol/g.
The presence of oleandrin and oleandrigenin in the snails was confirmed by liquid
chromatography–tandem mass spectrometry analysis, which was performed
on a ionic-trap Finnigan LXQ instrument using an electrospray ionization interface.
High-pressure liquid chromatographic separation was performed on a C18 column
with a gradient of methanol/water. An extract of oleander leaves was used as
reference.
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