Nine of ten weight-loss supplements were a poisonous plant instead

On 8 September 2022, an emergency physician rang the New Jersey poison
centre about a child aged 23 months who had swallowed a weight-loss
supplement their mother had bought, labelled Mexican Tejocote Root.

Cardenolides are the class of cardiac poison that includes digoxin.
Yellow oleander contains one, thevetin B.

The treatment, and the detail that nearly hid the diagnosis

A serum digoxin assay returned 0.5 ng/L — a level the poison centre read
as cross-reactivity with a non-digoxin cardiac glycoside, not as digoxin.
That interpretation is what connected a bradycardic toddler to a plant toxin.

The child was given digoxin-specific antibody fragments, the digoxin
antidote, and the ECG and blood pressure normalised.

Twelve hours later the ECG again showed cardenolide toxicity. A **second
dose** was needed before it stayed normal.

The relapse matters clinically: the toxin outlasted the first dose of antidote,
so a patient who looks recovered is not necessarily finished.

How widespread it was

The poison centre bought **10 products labelled tejocote and sold online as
weight-loss supplements** in December 2022 — each listed on a separate page,
though some carried the same or similar labels — and sent them to a laboratory
specialising in supplement analysis, which compared them against **authenticated
tejocote root** verified by an ethnobotanist.

**Nine of 10 products labelled as tejocote were yellow oleander, with no
evidence of tejocote root.**

Not contamination. Substitution — the labelled plant was simply absent, and a
cardiotoxic one was there instead.

What the regulation says, and what it delivered

**US dietary supplement regulations require that all ingredients be tested for
identity and be free from reasonably anticipated contaminants.**

Nine of ten products failed the first of those, and the failure was found only
because a toddler ended up in hospital and somebody thought to buy the rest.
Earlier DNA fingerprinting of another brand had already found it **100%
yellow oleander** — so this was known, and the products stayed on sale.

Source: Centers for Disease Control and Prevention, MMWR.