digitoxin and Acute-Disease

Although most acute pediatric ingestions of digoxin or other related cardiac glycosides result in minimal or no symptoms, occasionally a child is symptomatic. Gastrointestinal complaints or first-degree AV block are the most common presenting symptoms. Children can generally be given a single dose of activated charcoal, observed, and discharged without any subsequent problems. However, some patients will be toxic and require monitoring, medication, and possibly digoxin-specific antibody fragments. The most important role of the clinician is to recognize the clinical manifestations and institute the appropriate therapy. As in the case presented, the history of an ingestion may not always be obtained initially. Thus, the physician should maintain a high index of suspicion for acute digoxin ingestion and order the appropriate confirmatory tests (eg, a digoxin level, a potassium level, and a 12-lead ECG) when necessary.

Topics: Acute Disease; Cardiotonic Agents; Digitalis; Digoxin; Humans; Infant; Male; Plants, Medicinal; Plants, Toxic; Poisoning; United States

One day after drinking what she thought to be a tea made from borage leaves a 72-year-old woman developed nausea, vomiting and diarrhoea, later also flickering in her eyes and palpitations. She was in a good general state with a blood pressure of 120/75 mm Hg and an irregular heart rate of 52/min. Physical examination was otherwise unremarkable. She had not been on any medication.. The usual laboratory tests were normal. The electrocardiogram showed atrial fibrillation with a slow ventricular rate with pauses of up to 1.5s. intermittently type I and II 2 degrees AV block, and depressed concave ST segments. The level of digoxin was 3.93 ng/ml, that of digitoxin 133.5 ng/ml.. The patient's symptoms quickly improved under symptomatic treatment. Further questioning suggested that she had probably mistaken foxglove leaves for those of borage when picking them to make a brew.. If cardiac arrhythmias have occurred after intake of self-picked herbal leaves one should consider digitalis intoxication resulting from misidentification.

Topics: Acute Disease; Aged; Atrial Fibrillation; Bradycardia; Diarrhea; Digitalis; Female; Humans; Plant Poisoning; Plants, Medicinal; Plants, Toxic; Tea; Vomiting

Topics: Acute Disease; Angiotensin-Converting Enzyme Inhibitors; Catecholamines; Digitalis; Diuretics; Emergencies; Heart Failure; Humans; Phosphodiesterase Inhibitors; Plants, Medicinal; Plants, Toxic; Shock, Cardiogenic; Vasodilator Agents

Topics: Acute Disease; Adrenal Cortex Hormones; Anti-Bacterial Agents; Asthma; Bronchodilator Agents; Chronic Disease; Diagnosis, Differential; Digitalis; Electrocardiography; Heart Auscultation; Humans; Hypertension, Pulmonary; Phytotherapy; Plants, Medicinal; Plants, Toxic; Pulmonary Circulation; Pulmonary Emphysema; Pulmonary Heart Disease; Radiography; Streptokinase; Thromboembolism

Because life-threatening digitalis intoxication is unusual in children, treatment with digoxin-specific-antibody Fab fragments (Fab) has rarely been reported. We describe the efficacy of Fab in the treatment of children with severe digitalis intoxication.. Twenty-nine children with intoxication due to digoxin (28) or digitoxin (1) received Fab at 21 participating hospitals between 1974 and 1986. Data were gathered about the patients' medical illnesses, doses and serum concentrations of digitalis, responses to Fab therapy, and outcomes.. In the infants and young children with acute digoxin intoxication, the digoxin doses ranged from 0.30 to 0.96 mg per kilogram of body weight; two adolescents had severe intoxication after doses of only 0.20 and 0.26 mg per kilogram. The serum digoxin concentrations ranged from 3.0 to greater than 100 ng per milliliter (mean, 13.8). Atrioventricular block (present in 22 patients [76 percent]) was the most common sign of toxicity. All the patients in this series had severe disturbances of cardiac rhythm, hyperkalemia (mean serum potassium concentration, 5.4 mmol per liter), or both. In 27 patients (93 percent), digitalis toxicity resolved after the administration of Fab. Of the 19 patients for whom data were available on the timing of the response to Fab, 15 responded within 180 minutes. Three patients required retreatment with Fab. Seven died of complications unrelated to the administration of Fab.. We recommend that Fab be used in the treatment of digitalis poisoning in infants and young children who have ingested greater than or equal to 0.3 mg of digoxin per kilogram, who have underlying heart disease, or who have a serum digoxin concentration of greater than or equal to 6.4 nmol per liter (greater than or equal to 5.0 ng per milliliter) in the elimination phase; and who also have a life-threatening arrhythmia, hemodynamic instability, hyperkalemia, or rapidly progressive toxicity. Adolescents, who are more sensitive to the toxic effects of digoxin than younger children, may require treatment with Fab after ingesting lower doses.

Topics: Acute Disease; Adolescent; Arrhythmias, Cardiac; Child, Preschool; Digitoxin; Digoxin; Female; Heart Block; Heart Diseases; Humans; Hyperkalemia; Immunoglobulin Fab Fragments; Infant; Infant, Newborn; Male; Poisoning

Topics: Acute Disease; Aged, 80 and over; Convallaria; Digitalis; Female; Humans; Plant Components, Aerial; Plant Poisoning

Despite years of interest in the anti-cancerous effects of cardiac glycosides (CGs), and numerous studies in vitro and in animals, it has not yet been possible to utilize this potential clinically. Reports have demonstrated promising in vitro effects on different targets as well as a possible therapeutic index/selectivity in vitro and in experimental animals. Recently, however, general inhibition of protein synthesis was suggested as the main mechanism of the anti-cancerous effects of CGs. In addition, evidence of species differences of a magnitude sufficient to explain the results of many studies called for reconsideration of earlier results.. In this report we identified primary B-precursor and T-ALL cells as being particularly susceptible to the cytotoxic effects of CGs. Digitoxin appeared most potent and IC(50) values for several patient samples were at concentrations that may be achieved in the clinic. Significant protein synthesis inhibition at concentrations corresponding to IC(50) was demonstrated in colorectal tumour cell lines moderately resistant to the cytotoxic effects of digoxin and digitoxin, but not in highly sensitive leukaemia cell lines.. It is suggested that further investigation regarding CGs may be focused on diagnoses like T- and B-precursor ALL.

Topics: Acute Disease; Cardiac Glycosides; Cell Line, Tumor; Colorectal Neoplasms; Digitoxin; Humans; Inhibitory Concentration 50; Leukemia; Leukemia, B-Cell; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma; Protein Biosynthesis; Species Specificity

Advanced Digitalis intoxication is a rare event, mainly associated with overdose in patients with Digitalis therapy. We report an unusual case of acute 'familiar' digitalis poisoning in three patients who had eaten potato dumplings flavoured with leaves of Borago officinalis L. unconsciously mixed with leaves of Digitalis purpurea L. A complicated clinical course with marked bradyarrhythmias was presented, with good evolution thanks to the use of digoxin-specific antibody Fab fragments. The theme of the domestic use of plants with medicinal effects has been treated and discussed.

Topics: Acute Disease; Adult; Antidotes; Bradycardia; Cardiac Glycosides; Charcoal; Digitalis; Electrocardiography; Female; Food Contamination; Heart Rate; Humans; Immunoglobulin Fab Fragments; Male; Middle Aged; Plant Leaves; Poisoning

Topics: Acute Disease; Acute Kidney Injury; Aged; Antibodies; Digitalis; Digoxin; Humans; Immunoglobulin Fab Fragments; Immunoglobulin Fragments; Plasmapheresis

Because of the paucity of information on the epidemiology of acute poisoning requiring intensive medical care, all such patients treated on the medical intensive care unit of the university hospital in Frankfurt am Main, Germany, between January 1993 and December 1999, were retrospectively evaluated.. Of the total of 6211 patients, 147 (80 women, 67 men, mean age 41 years, 2,3 %) were treated for acute intoxication in the intensive care unit.. Reasons for admission to the intensive care unit were the need for ventilator treatment or intensive monitoring of vital functions. 52 % of the patients (n = 76) had attempted suicide, most of them using anti-depressive drugs (n = 19), paracetamol (n = 16), or benzodiazepines (n = 9). Two patients (2,6 %) died. 48 % of the patients (n = 71) were admitted because of accidental poisoning. Leading toxic agents in this group were heroin (n = 19), alcohol (n = 18) and digitalis (n = 12). 11 patients had taken herbicides, animal poisons or chemicals used at work or for house cleaning. In this cohort, three i. v. drug abusers (4,2 %) had died. Depending on the agents used, a variety of treatments (charcoal, antidots, extracorporal therapy) were undertaken.. Due to excellent care in the prehospital phase and in the emergency room the number of patients requiring treatment on the intensive care unit was rather low. The mortality was in the range of other reports.

Topics: Accidents; Acetaminophen; Acute Disease; Adult; Analgesics, Non-Narcotic; Antidepressive Agents; Antidotes; Benzodiazepines; Charcoal; Cohort Studies; Digitalis; Emergency Medical Services; Emergency Service, Hospital; Female; Germany; Herbicides; Hospitals, University; Household Products; Humans; Intensive Care Units; Male; Monitoring, Physiologic; Poisoning; Respiration, Artificial; Retrospective Studies; Sex Factors; Suicide, Attempted

The early and long-term results of both surgical and nonsurgical therapy for 160 patients with acute aortic dissection in our institution were analyzed. Of the 83 patients with acute type A aortic dissection, 47 received surgery during acute stage, 10 received it in the chronic stage, and 26 received nonsurgical therapy. Of the 77 patients with acute type B aortic dissection, 27 received surgery during acute stage, 22 received it in the chronic stage, and 28 received nonsurgical therapy. Ten-year survival rates for patients receiving surgery during the acute stage were 62% for type A and 64% for type B dissection. This survival rate for type A patients was significantly higher than that for type A patients not receiving surgery, but the corresponding difference for type B patients was not significant. Present data indicate that immediate surgical intervention is indicated in patients with acute type A dissection, and elective operation in the subacute stage in patient with uncomplicated type B dissection following medical therapy in the acute stage.

Topics: Acute Disease; Adrenergic beta-Antagonists; Aorta; Aortic Aneurysm; Aortic Dissection; Blood Vessel Prosthesis; Digitalis; Diuretics; Follow-Up Studies; Humans; Plants, Medicinal; Plants, Toxic; Survival Rate; Time Factors

Life-threatening digitalis intoxication is treated using digoxin specific antibody fragments (Fab) that bind and inactivate the drug. The free digoxin serum concentration could be useful in the management of Fab-treated patients, but the standard methods of measurement can be clinically misleading because Fab anti-digoxin interferes with digitalis immunoassay measurements. A case involving Fab therapy of a digoxin overdosed patient, in which two laboratory methods gave very different results, is reported. The radioimmunologic assay (RIA), widely used in laboratories, yielded high values without relation to true serum free digoxin concentration. On the contrary, the recently introduced fluoroenzymatic sequential immunoassay (FEIA), which accurately measures free glycoside concentration, was a valuable aid in monitoring Fab treatment. Therefore, cardiologists' knowledge of a possible interference of specific anti-digoxin fragment treatment with many immunoassays may greatly enhance the rational management of these patients.

Topics: Acute Disease; Aged; Digitalis; Digoxin; Drug Overdose; Female; Humans; Immunoglobulin Fab Fragments; Monitoring, Physiologic; Plants, Medicinal; Plants, Toxic; Poisoning

A 50-year-old, previously healthy, woman swallowed 1 g digoxin powder, dissolved in water, with suicidal intent. On admission to hospital one hour later, having vomited three times at home, the prominent signs were somnolence and hypersalivation. Serum digoxin level was 3.37 ng/ml. There followed repeated episodes of asystole alternating with ventricular fibrillation requiring cardiopulmonary resuscitation over 90 min and adrenaline administration. Repeated electrical defibrillation, administration of dopamine, phenytoin and lidocaine, as well as transitory transvenous electrical stimulation became necessary. Anti-digoxin antibody fragments were administered, initially 80 mg, to a total of 3,280 mg over 24 hours. After 3 days of intensive care and a further 21 days in hospital she was discharged and referred to psychiatric treatment. This case demonstrates that even severe digoxin poisoning can be successfully treated without sequelae by the appropriate administration of digoxin antidote. The main problems in this case were regulation of the dosage and acquiring the necessary amount of antidote which greatly exceeded the hospital's own depot.

Topics: Acute Disease; Antidotes; Combined Modality Therapy; Digitalis; Digoxin; Drug Overdose; Drug Therapy, Combination; Female; Gastric Lavage; Humans; Middle Aged; Plants, Medicinal; Plants, Toxic; Poisoning; Powders; Suicide, Attempted; Ventricular Fibrillation

In the framework of the secondary prevention after acute myocardial infarction the interaction between physical conditioning (pK) and medicamentous therapy was analysed and a retrospective evaluation of the therapy was performed during the rehabilitation phase III. During the physical conditioning (n = 110) in 31% of the patients changes of the medicamentous therapy rendered themselves necessary (15% increase of the dose, 16% reduction of the dose and withdrawal of a medicament, respectively). In the rehabilitation phase III (n = 277) 72% of the patients were given nitrates, 68% calcium antagonists and 55% beta-receptor blocking agents (43% double, 29% triple combinations) and 15% digitoxin. The aim of the medicamentous therapy is the treatment of the myocardial ischaemia and its sequels, taking into consideration the positive effects of the physical conditioning and the influence on the quality of life.

Topics: Acute Disease; Adrenergic beta-Antagonists; Aged; Anti-Arrhythmia Agents; Antihypertensive Agents; Calcium Channel Blockers; Cardiovascular Agents; Digitoxin; Drug Therapy, Combination; Exercise Therapy; Female; Humans; Male; Middle Aged; Myocardial Infarction; Nitrates; Retrospective Studies

After presenting the case of a 70 year old woman who presented a massive mesenteric infarction as a result of non-occlusive intestinal ischaemia ( NOII ), the authors review the principal features of this particular form of intestinal ischaemia. This condition is seen principally in elderly people with a syndrome of low cardiac output, resulting in marked mesenteric vasoconstriction. It is a complication of either severe decompensated heart disease treated with digitaloids or to a state of hypovolaemic or septic shock. The diagnosis of NOII should be suggested by the combination of abdominal signs with a state of shock and/or treated heart disease. The diagnosis is confirmed by selective mesenteric arteriography which reveals a patent but spastic vessel. The treatment is initially medical, consisting of the correction of haemodynamic disturbances and the in situ injection of vasodilator products, which may need to be completed by a surgical operation. However, the prognosis of NOII remains serious, particularly because of the frequent delay in making the diagnosis.

Topics: Acetyldigitoxins; Acute Disease; Aged; Cardiac Glycosides; Digitoxin; Female; Humans; Intestines; Ischemia

After a survey of conventional and modern therapeutic strategies in pulmonary edema, a simple clinical approach to the management of this cardiac emergency is suggested. The central role of chlorpromazine, as a vasodilator drug, is also stressed.

Topics: Acute Disease; Blood Pressure; Chlorpromazine; Digitalis; Diuretics; Furosemide; Heart; Humans; Morphine; Nitroglycerin; Nitroprusside; Oxygen Inhalation Therapy; Plants, Medicinal; Plants, Toxic; Pulmonary Edema; Vasodilator Agents

The prognostic significance of various clinical and biochemical factors was investigated in 179 patients who had ingested more than 2 mg digitoxin. The mortality rate in this series was 17%. Supraventricular arrythmias had no influence on prognosis, but the death risk was higher in males and in patients with AV block. It increased with age, with digitoxin and potassium serum levels and even more with persistent hyperkalemia. Two other factors--previous heart disease and vomiting--were also significant in patients without heart block. Calculated on the basis of 4 clinical factors, the mortality rate varied from 2 to 74%. The death risk in acute digitalis poisoning can therefore be easily assessed simply from clinical criteria.

Topics: Acute Disease; Age Factors; Digitoxin; Female; Humans; Male; Middle Aged; Prognosis; Sex Factors

Topics: Acute Disease; Adrenal Cortex Hormones; Altitude; Capillary Permeability; Digitalis; Heart Diseases; Humans; Plants, Medicinal; Plants, Toxic; Pulmonary Edema

Topics: Acute Disease; Digitalis; Drug Evaluation; Heart Failure; Hemodynamics; Humans; Myocardial Infarction; Plants, Medicinal; Plants, Toxic

Topics: Acute Disease; Animals; Digitalis; Digitalis Glycosides; Dogs; Histocytochemistry; Microscopy, Electron; Myocardium; Plants, Medicinal; Plants, Toxic

The prognostic significance of various clinical and biochemical factors was investigated in 179 patients who had absorbed more than 2 mg of digitoxin. The mortality rate in this series was 17%. Supraventricular arrythmias had no influence on prognosis, but the death risk was higher in males and in patients with A-V block. It increased with age, with digitoxin and potassium serum levels and even more with persistent hyperkalemia. Two other factors, previous heart disease and vomiting, were also significant in patients without heart block. Calculated on the basis of 4 clinical factors, the mortality rate varied from 2 to 74%. The death risk in acute digitalis poisoning can therefore be easily assessed from simple clinical criteria.

Topics: Acute Disease; Age Factors; Digitoxin; Female; Heart Block; Humans; Male; Middle Aged; Potassium; Prognosis; Sex Factors; Suicide, Attempted

Topics: Acute Disease; Adolescent; Adult; Aged; Animals; Digitoxin; Digoxin; Dogs; Hemoperfusion; Humans; Middle Aged; Polystyrenes; Polyvinyls

Topics: Acute Disease; Anti-Arrhythmia Agents; Digitalis Glycosides; Digitoxin; Humans

Topics: Acute Disease; Acute Kidney Injury; Anticoagulants; Contraceptives, Oral; Digitoxin; Female; Hemolysis; Humans; Nephritis, Interstitial; Rifampin; Thrombocytopenia; Tuberculosis

Topics: Acute Disease; Blood Pressure; Cardiac Output; Coronary Circulation; Depression, Chemical; Digitalis; Digitalis Glycosides; Furosemide; Heart; Heart Rate; Humans; Myocardial Infarction; Norepinephrine; Oxygen Consumption; Phentolamine; Plants, Medicinal; Plants, Toxic; Propranolol; Stimulation, Chemical; Vascular Resistance

Topics: Acute Disease; Bundle-Branch Block; Computers; Coronary Vessels; Diagnosis, Computer-Assisted; Diagnosis, Differential; Diaphragm; Digitalis; Electrocardiography; Heart Block; Heart Diseases; Heart Rate; Heart Ventricles; Humans; Hypertrophy; Infarction; Ischemia; Mathematics; Mitral Valve; Myocardial Infarction; Pericarditis; Plants, Medicinal; Plants, Toxic; Potassium

Topics: Acute Disease; Aged; Arrhythmias, Cardiac; Coronary Disease; Digitalis Glycosides; Digitoxin; Digoxin; Electrocardiography; Female; Humans; Lung Diseases; Male; Myocardial Infarction; Poisoning; Prognosis; Prospective Studies; Radioimmunoassay

Topics: Acute Disease; Adolescent; Adult; Aged; Child; Digitoxin; Electrocardiography; Heart; Heart Diseases; Humans; Middle Aged

Topics: Acute Disease; Adult; Aged; Anticoagulants; Arrhythmias, Cardiac; Digitoxin; Electrocardiography; Female; Furosemide; Heart Arrest; Heart Block; Heart Massage; Humans; Intensive Care Units; Isoproterenol; Male; Middle Aged; Myocardial Infarction; Nitroglycerin; Pacemaker, Artificial; Ventricular Fibrillation

Topics: Acute Disease; Assisted Circulation; Digitalis; Hemodynamics; Humans; Isoproterenol; Myocardial Infarction; Plants, Medicinal; Plants, Toxic; Plasma Substitutes; Shock; Vasoconstrictor Agents; Vasodilator Agents

Topics: Acute Disease; Cardiovascular Diseases; Digitalis; Digitalis Glycosides; Humans; Myocardial Infarction