Death from cardiac glycoside “pong-pong” following use as weight-loss supplement purchased on Internet

• Published in: The American journal of emergency medicine Vol. 38; no. 8; pp. 1698.e5 - 1698.e6
• Main Authors: Nordt, Sean Patrick, Hendrickson, Matt, Won, Kimberly, Miller, Matthew J., Swadron, Stuart P., Cantrell, F. Lee
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2020; Elsevier Limited
• Subjects: Blood pressure; Bradycardia; Cardiac glycoside; Cardiac glycosides; Cardiopulmonary resuscitation; Case reports; Cerbera odollam; Chloride; CPR; Creatinine; Dietary supplements; Digoxin; EKG; Emergency medical care; Fibrillation; Glycosides; Heart rate; Hyperkalemia; Ingestion; Internet; Mortality; Nerium; Poisoning; Pong-pong; Potassium; Sodium; Suicide; Suicides & suicide attempts; Vomiting; Weight loss; Cardiac glycoside; Pong-pong; Cerbera odollam; Poisoning; Weight loss
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2020.04.063

Cerbera odollam or “pong-pong” tree contains cardiac glycosides similar to digoxin, oleander and yellow oleander. Cerbera odollam is a common method of suicide in South East Asia and has also been used as a weight loss supplement. We present a case of a 33-year-old female presenting with lethargy, vomiting, bradycardia, severe hyperkalemia of 8.9 mEq/L, slow atrial fibrillation followed by cardiovascular collapse following the ingestion of “pong-pong”, the kernel of Cerbera odollam, as a weight loss supplement. Despite the administration of a total of nine vials of digoxin-specific Fab the patient could not be resuscitated. Clinicians should be aware of natural cardiac glycosides being uses as weight-loss agents and consider acute cardiac glycoside poisoning in patients with hyperkalemia, abnormal cardiovascular signs, symptoms and abnormal ECG findings.