• Sean Patrick Nordt, Matt Hendrickson, Kimberly Won, Matthew J Miller, Stuart P Swadron, and F Lee Cantrell.
• University of Southern California, Department of Emergency Medicine, Los Angeles, CA, United States of America; University of California, Irvine, Department of Emergency Medicine, Orange, CA, United States of America; Chapman University, School of Pharmacy, Irvine, CA, United States of America. Electronic address: spnordt@hotmail.com.
• Am J Emerg Med. 2020 Aug 1; 38 (8): 1698.e5-1698.e6.

AbstractCerbera 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.Copyright © 2020 Elsevier Inc. All rights reserved.

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