Yellow oleander (Thevetia peruviana family Apocynaceae) is an ornamental plant; with yellow bell shaped flowers and is a tree native to Mediterranean (5, 13). The fruit is globular light green about 4-5 cm in diameter and contain a single nut which is triangular with a deep groove along the edge. Each nut contains five pale yellow seeds (4). Since ancient times it has been known toxic to humans. It has been used by Africans as an arrow poison, Greeks believed it to be poisonous to “all four footed beasts” (5). All parts of the plant are poisonous especially seeds, stems, and roots with highest toxin concentration occurring during the peak flowering stages (5). Various toxins, which are cardiac glycosides chemically, have been isolated; oleandrin, digitoxigenin, nerium folinerium, rosagenin, theventin A & B thevetoxin, peruvoside, ruvoside, cerberin, oleandroside, and also a bitter principle that act on the CNS and produces tetanoid convulsions(3,4,6,10,15). They have digoxin like effect by inhibiting Na+K+ ATPase pump (6,13). The highest oleandrin concentrations are found in the leaves (6). The clinical presentation usually resembles digoxin poisoning with gastrointestinal symptoms (Nausea, vomiting and mucosal erythema) and cardiovascular complications (bradydysrhythmias, sinus bradycardia with all types of AV nodal block, junctional rhythms, and sinus arrest, tachydysrhythmias, such as atrial tachycardia with block, Junctional tachycardia, Ventricular tachycardia, Ventricular fibrillation, Paroxysmal atrial tachycardia with block, Bidirectional ventricular tachycardia, ventricular fibrillation) and death (3,5,10). In addition, there may be paresthesias, weakness, hypertonia and excessive salivation and altered sensorium (3,10). The postmortem appearance shows generalized hemorrhages and signs of gastrointestinal irritation (11).

The Budd-chiari syndrome is a heterogeneous group of disorders characterized by hepatic venous outflow obstruction at the level of the hepatic venules, the large hepatic veins, the IVC or the right atrium(1). Hyper coagulable states of the blood are the most common etiology of this disorder(2); amongst which sickle cell disease is a rare cause(2). This part of Orissa is having high incidence of SCD and trait. No such case report has been done earlier.
Sickle cell disease is a type of Hemoglobinopathy characterized by production of abnormal sickle Hemoglobin (Hbs). This abnormality is due to the substitution of valine for glutamic acid at the 6th position of  chain of globin(34). The abnormal HbS tends to polymerize on deoxygenation and the RBCs containing HbS become less pliable and consequently deform into the characteristic sickle shape, for which the disease is named so. This disorder is acquired by inheriting abnormal sickle genes from both the parents.