Following a meal of snail stew made of snails collected locally, a 66 year old man and a 43 year old woman developed symptoms of the abdomen and symptoms related to the heart. They went to the hospital after 12 hours with symptoms suggestive of digoxin ingestion as follows: nausea, vomiting, diarrhea and “heart related symptoms.”
The man had an abnormal EKG. Both of the subjects had elevated digoxin levels. The digoxin levels had gone down by the second day and the patients were well by the third day. Some of the snails were collected and tested and found to have quite high levels of digoxin activity.
The snails were found to contain oleandrin and oleandrigenin. These chemicals are found in the leaves and flowers of Nerium oleander plants. Oleander is widely planted as an ornamental bush in Italian climates. These plants contain many cardiac glycoside chemicals which are insecticidal, cardiotonic (increase heart muscle contraction strength) and anti-cancer.
Foxglove (Digitalis purpurea) contains some of the same chemicals and grew in the couple’s garden, also.
CONCLUSION: The presumed cause of the couple’s digoxin toxicity was eating snails which may have fed on oleander plants containing cardiac glycosides. The same symptoms can result from eating the oleander leaves.
NOTE: Chemicals with cardiac glycoside activity can cause heart symptoms and appear as digoxin activity on blood testing. This is especially true in people with a low serum potassium level. Some plants with cardiac glycoside activity include the following: bacopa (Bacopa monniera or Bacopa monnieri,) white bryony (Bryonia alba,) greater celandine (Chelidonium majus,) myrrh (Commiphora molmol,) English hawthorne (Crataegus spp.,) eleuthero (Eleutherococcus senticosus,) ginkgo (Ginkgo biloba,) American ginseng (Panax quinquefolius,) parsley (Petroselimun crispus) and Chinese rhubarb (Rheum palmatum.)
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