digitoxin and Hyperkalemia

Digoxin is recommended in symptomatic heart failure patients with reduced ejection fraction (HF-REF) in sinus rhythm and refractory to other evidence-based therapy. Although HF-REF patients with diabetes have worse functional status than those without, the effects of digoxin have not been specifically evaluated according to diabetes status.. We examined the efficacy and safety of digoxin in HF-REF patients with and without diabetes in the Digitalis Investigation Group trial. Mortality from all-cause, cardiovascular (CV) causes and heart failure (HF), along with HF hospitalisation and suspected digoxin toxicity were analyzed according to diabetes status and randomised treatment assignment.. Of the 6800 patients, those with diabetes (n=1933) were older, more often women, had worse clinical status and more co-morbidity than those without diabetes. All-cause and CV mortality were higher in patients with diabetes than in those without and digoxin did not reduce mortality in either sub-group. The rate of HF hospitalization (per 100 person-years) in patients with diabetes was higher than in those without and was reduced by digoxin in both patient groups: diabetes - placebo 20.5 and digoxin 16.0 (HR 0.79, 95% CI: 0.68-0.91); no diabetes - placebo 12.7 and digoxin 8.7 (HR 0.69, 0.62-0.77); interaction p=0.14. Suspected digoxin toxicity in patients randomised to digoxin was more common among patients with diabetes than without (6.5% versus 5.8%), as was hospitalisation for digoxin toxicity (1.4% versus 0.8%).. Added to an ACE inhibitor, digoxin reduced HF hospitalisation in HF-REF patients with and without diabetes without a substantial risk of toxicity.

Topics: Aged; Cardiotonic Agents; Diabetes Mellitus; Digitalis; Digoxin; Female; Heart Failure; Hospitalization; Humans; Hyperkalemia; Male; Middle Aged; Retrospective Studies; Risk Factors; Stroke Volume; Treatment Outcome

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

We report a case of a 19-year-old woman who ingested Digitalis purpurea leaves as a suicide attempt. She developed gastro-intestinal symptoms, loss of colour vision, cardiac conduction disturbances as well as an elevated serum potassium. Treatment was initiated in analogy to medicinal digoxin poisoning by means of digoxin-specific Fab-fragments with a good effect. However during the further course we faced difficulties of prolonged intestinal absorption and inability to estimate the ingested dose or half-life of the vegetal cardiac glycoside compounds. To prevent further absorption and interrupt enterohepatic recycling, multi-dose activated charcoal was administered. Because of a relapse of cardiac conduction disturbances and hyperkalemia, two supplementary doses of Fab-fragments were given, up to a total dose of nineteen vials (one vial containing 40 mg). The important diagnostic and therapeutic differences of vegetal digitalis intoxication as compared to medicinal intoxication and the applicability of existing guidelines on medicinal digitalis intoxication in the light of these differences will be discussed here.

Topics: Adult; Digitalis; Digitalis Glycosides; Digoxin; Female; Humans; Hyperkalemia; Immunoglobulin Fab Fragments; Young Adult

Topics: Aged; Antidotes; Arrhythmias, Cardiac; Digitalis; Digoxin; Electrocardiography; Female; Humans; Hyperkalemia; Male; Nausea; Vomiting

Cardiac glycoside toxicity is frequently associated with hyperkalemia and dysrhythmias in patients with renal insufficiency. Two common therapeutic options for these complications (calcium and transvenous cardiac pacing) are considered contraindicated in the setting of cardiac glycoside toxicity. We present the case of a patient presenting with a pronounced bradydysrhythmia and hyperkalemia who was treated with intravenous calcium and transvenous cardiac pacing and later found to have digitalis toxicity and acute renal failure. There were no adverse events associated with the therapies. The patient received digoxin-specific Fab fragments and hemodialysis as definitive therapeutic modalities. The case and the relevant literature evaluating the interaction of calcium salts and cardiac pacing in the setting of cardiac glycoside toxicity are discussed.

Topics: Acute Kidney Injury; Aged; Aged, 80 and over; Digitalis; Female; Humans; Hyperkalemia; Renal Dialysis

Topics: Adrenergic beta-Antagonists; Amiodarone; Digitalis; Education, Medical, Continuing; Electrocardiography; Humans; Hypercalcemia; Hyperkalemia; Hypocalcemia; Hypokalemia; Plants, Medicinal; Plants, Toxic; Quinidine

Topics: Antihypertensive Agents; Diet; Digitalis; Heparin; Humans; Hyperkalemia; Plants, Medicinal; Plants, Toxic; Potassium; Renal Dialysis; Uremia

In a prospective and a retrospective study, the effects of hyperkalemia on the electrocardiogram (ECG) of patients treated with customary maintenance doses of digoxin were examined and the results were compared with the effects of hyperkalemia in patients not receiving digitalis. The prospective study included 11 patients treated and 11 not treated with digitalis, and the retrospective study 27 patients treated and 61 not treated with digitalis. In all patients serum potassium concentrations (Ks) were determined within 1 hour of the recorded electrocardiogram. Serum digoxin concentrations, measured in 11 patients in the prospective and in 4 in the retrospective study, ranged from 0.7 to 5.0 ng/ml, and exceeded 2.0 ng/ml in 10 of 15 patients. Since the results of the prospective and of the retrospective study were similar, they were combined. In patients treated with digitalis, Ks ranged from 5.5 to 6.6 mEq/liter in 21 patients, from 6.7 to 7.5 mEq/liter in 17 and from 7.6 to 8.5 mEq/liter in 6; the Ks was 9.1 mEq/liter in 1 patient. The ventricular rate in patients treated with digitalis ranged from 48 to 140 beats/min, and was not significantly different from that in untreated patients within each range of Ks. Atrioventricular (AV) junctional rhythm occurred more frequently in the electrocardiograms of digitalis-treated patients (15 of 45 vs 2 of 76, p less than 0.001). The average PR intervals were longer in patients treated with digitalis who had Ks greater than 6.6 mEq/liter, but no patient in the study had greater than first-degree AV block, and no patient required a pacemaker.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Arrhythmias, Cardiac; Digitalis; Digoxin; Electrocardiography; Female; Heart Rate; Humans; Hyperkalemia; Male; Middle Aged; Plants, Medicinal; Plants, Toxic; Prospective Studies; Retrospective Studies

The narrow therapeutic range of digitalis glycosides and the danger of intoxication has prompted a search for alternative medication in recent years. Substances reducing the pre- and afterload of the heart are suitable therapeutic agents and vasodilators are, therefore, used as adjuvant or alternative therapy. Of all positive inotropic substances only the catecholamines play an established part in the treatment of acute myocardial failure. Pilot studies testing orally administrable positive inotropic substances are being conducted, but for the moment no such drugs are available for routine use. Digitalis still remains the drug of choice for all forms of primary impairment of contractility and/or supraventricular tachyarrhythmias. The appropriate dosage has to be adapted to the estimated lean body mass and, if necessary, reduced in a thin person, Digitoxin is preferentially used in cases with suspected renal insufficiency (especially in elderly patients).

Topics: Arrhythmias, Cardiac; Digitalis Glycosides; Digitoxin; Diuretics; Heart Failure; Heart Rate; Humans; Hyperkalemia; Myocardial Contraction; Vasodilator Agents

Topics: Adolescent; Adult; Age Factors; Aged; Anti-Arrhythmia Agents; Cardiac Catheterization; Digitoxin; Electrocardiography; Female; Heart Arrest; Heart Injuries; Heart Valve Diseases; Humans; Hyperkalemia; Male; Middle Aged; Pacemaker, Artificial; Prognosis; Sepsis; Shock, Cardiogenic; Thrombosis; Time Factors; Ventricular Fibrillation

Topics: Adolescent; Adult; Aged; Digitalis Glycosides; Digitoxin; Female; Humans; Hyperkalemia; Male; Middle Aged; Poisoning; Spectrophotometry; Suicide

Topics: Adolescent; Adult; Aged; Digitalis Glycosides; Digitoxin; Female; Humans; Hyperkalemia; Male; Middle Aged; Poisoning; Spectrophotometry; Suicide

Topics: Animals; Digitalis; Dogs; Hyperkalemia; Hypokalemia; Insulin; Isoproterenol; Membrane Potentials; Plants, Medicinal; Plants, Toxic; Ventricular Fibrillation

Topics: Digitalis; Electrolytes; Guinea Pigs; Heart Failure; Hemodynamics; Hyperkalemia; Hypokalemia; Metabolism; Myocardium; Pharmacology; Potassium; Sodium; Strophanthins; Toxicology

Topics: Child; Diagnosis, Differential; Digitalis; Electrocardiography; Geriatrics; History; Humans; Hyperkalemia; Toxicology; Vectorcardiography

Topics: Blood Transfusion; Death; Death, Sudden; Digitalis; Digitalis Glycosides; Hyperkalemia; Myocardial Infarction; Surgical Procedures, Operative; Toxicology

Topics: Acidosis; Angina Pectoris; Digitalis; Digitalis Glycosides; Drug Therapy; Electrocardiography; Humans; Hyperkalemia; Kidney Diseases; Potassium; Toxicology; Uremia; Water-Electrolyte Balance

Topics: Arrhythmias, Cardiac; Cations; Chlorides; Digitalis; Digitalis Glycosides; Dogs; Electric Stimulation; Electrocardiography; Hyperkalemia; Myocardium; Pacemaker, Artificial; Pharmacology; Potassium; Research; Toxicology

Topics: Animals; Arrhythmias, Cardiac; Breast; Diarrhea; Digitalis; Digitalis Glycosides; Dogs; Drug Hypersensitivity; Endocrine Glands; Eye Manifestations; Hyperkalemia; Hypertrophy; Neurologic Manifestations; Toxicology

Topics: Digitalis; Digitalis Glycosides; Health; Heart; Humans; Hyperkalemia; Toxicology

Topics: Blood Chemical Analysis; Calcium; Calcium, Dietary; Digitalis; Digitalis Glycosides; Electrocardiography; Electrolytes; Humans; Hypercalcemia; Hyperkalemia; Hypernatremia; Hypokalemia; Metabolism; Myocardium; Potassium; Sodium