digitoxin and Plant-Poisoning

Although death owing to the toxic effects of the therapeutic Digitalis lanata extract, digoxin has been reported, there are no reported cases of fatal Digitalis purpurea (digitoxin) plant intoxication in humans in the literature. We describe a case of ingestion of Digitalis purpurea in a 64-year-old man, which was fatal despite administration of Digibind. A review of the literature and aspects of management of plant digitalis poisoning are discussed.

Topics: Atropine; Cardiac Pacing, Artificial; Charcoal; Digitalis; Digoxin; Famous Persons; Fatal Outcome; Humans; Immunoglobulin Fab Fragments; Male; Middle Aged; Plant Poisoning; Suicide

This article discusses poisonous plants, the symptoms that might arise if they are ingested, and the treatments that should be administered to patients.

Topics: Aconitum; Cicuta; Colchicum; Datura stramonium; Digitalis; Humans; Nerium; Plant Poisoning; Plants, Toxic; Solanum; Veratrum

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: Albumins; Alkaloids; Atropine; Atropine Derivatives; Basidiomycota; Charcoal; Child; Digitalis; Gastroenteritis; Humans; Mouth; Mushroom Poisoning; Nicotine; Phenytoin; Physostigmine; Plant Poisoning; Plants; Plants, Medicinal; Plants, Toxic; Poisons; Potassium Chloride; Renal Dialysis; Seizures; Toxins, Biological; Vomiting; Water-Electrolyte Balance

Topics: Aged; Digitalis; Dose-Response Relationship, Drug; Female; Humans; Immunoglobulin Fab Fragments; Plant Poisoning; Treatment Outcome

Topics: Cardiovascular Agents; Comfrey; Digitalis; Digoxin; Humans; Plant Poisoning

Topics: Atrioventricular Block; Digitalis; Digoxin; Dose-Response Relationship, Drug; Electrocardiography; Humans; Plant Leaves; Plant Poisoning; Suicide, Attempted

Accidental ingestion of foxglove (Digitalis purpurea) can cause significant cardiac toxicity. We report a patient who ingested foxglove mistaking it for comfrey and developed refractory ventricular arrhythmias. The patient died despite treatment with digoxin-specific antibody fragments (DSFab) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO).. A 55-year-old woman presented to the emergency department with nausea, vomiting and generalized weakness eight hours after drinking "comfrey" tea. She had bradycardia (54 beats/min) and hyperkalemia (7.6 mEq/L). Electrocardiogram revealed a first-degree atrioventricular conduction block with premature atrial contractions, followed by polymorphic ventricular tachycardia three hours after arrival. A serum digoxin level was 151.2 ng/mL. The patient developed ventricular fibrillation while waiting for Digibind infusion. Resuscitation was performed and an emergent VA-ECMO was set up. A total of eight vials of Digibind were given over the next 16 hours. She temporarily regained consciousness, but remained hemodynamically unstable and subsequently developed lower limb ischemia and multiple organ failure, and she expired on hospital day seven. A botanist confirmed that the plant was foxglove.. The diagnosis of cardiac glycoside plant poisoning can be difficult in the absence of an accurate exposure history. In facilities where DSFab is unavailable or insufficient, early VA-ECMO might be considered in severely cardiotoxic patients unresponsive to conventional therapy.

Topics: Accidents; Cardiac Glycosides; Cardiotoxicity; Comfrey; Digitalis; Electrocardiography; Extracorporeal Membrane Oxygenation; Fatal Outcome; Female; Heart Diseases; Humans; Immunoglobulin Fab Fragments; Middle Aged; Plant Poisoning; Predictive Value of Tests; Resuscitation; Time Factors; Treatment Outcome

Topics: Digitalis; Humans; Plant Extracts; Plant Poisoning; Taxus

A previously well woman aged 63 years presents to the emergency department with vomiting, palpitations and 3 presyncopal episodes. She had no previous medical or cardiac history, with the patient stating that she tried a herbal remedy of boiled comfrey leaves for insomnia 18 hours before arrival to the department. Her ECG showed multiple abnormalities, including bradycardia, second-degree atrioventricular node block, Mobitz Type 2, a shortened QT interval, downsloping ST depression and presence of U waves. After viewing the images of comfrey and foxglove, it highlighted the possibility of mistaken ingestion of Digitalis, containing the organic forms of cardiac glycosides, such as digoxin and digitoxin. Raised serum digoxin levels confirmed this. The patient was haemodynamically stable, and given digoxin-binding antibodies. After 5 days of cardiac monitoring, her ECG returned to normal rhythm, and she was discharged home.

Topics: Accidents; Antibodies, Heterophile; Atrioventricular Block; Bradycardia; Comfrey; Digitalis; Digoxin; Electrocardiography; Female; Humans; Middle Aged; Plant Leaves; Plant Poisoning; Plants, Medicinal; Sleep Initiation and Maintenance Disorders; Treatment Outcome; Vomiting

A 58 years healthy old woman was admitted to the Emergency Department (ED) with cardiac arrest due to ventricular fibrillation (VF). Appropriate cardiopulmonary resuscitation (CPR), multiple DC shocks and oro-tracheal intubation (OTI) were effective to induce recovery of spontaneous circulation (ROSC). After ROSC was achieved, the electrocardiogram (ECG) showed an idio-ventricular rhythm with atrioventricular dissociation. A transcutaneous pacing was hence applied and the patient was administered with isoproterenol. Simultaneously, her husband was evaluated in the ED for gastrointestinal symptoms occurred after assumption of home-made "tortelli" (ravioli-like pasta) stuffed with cheese and leaves of a plant which they supposed to be borage two days before admission. Borage, during the non-flowering seasons, can be easily confused with foxglove (Digitalis spp.), and this was the main clue to suspect poisoning. Both patients were given DigiFab®, a sheep antibody fragment with high affinity for digoxin. The woman was then admitted in intensive care unit (ICU), where a rapid clinical  improvement occurred, thus allowing discharge in a few days. The husband was instead discharged from the ED after clinical observation and ECG monitoring. In both cases, a significant plasma concentration of digoxin could be measured.

Topics: Aged; Borago; Digitalis; Electrocardiography; Female; Heart Arrest; Humans; Male; Middle Aged; Plant Poisoning; Severity of Illness Index

Plant poisonings are rare in Denmark, but can have fatal consequences. We present a case in which a woman went into cardiac arrest after having ingested leaves from the foxglove plant. Sinus rhythm was not restored until Digibind was administered. Literature in this field is sparse, but we conclude that the following advice can be given: 1) assessment of the degree of poisoning should be based on clinical features and changes of the electrocardiogram; 2) activated charcoal should be given; 3) in case of malignant arrhythmia or cardiac arrest, the use of Digibind should be considered.

Topics: Digitalis; Electrocardiography; Female; Heart Arrest; Humans; Immunoglobulin Fab Fragments; Immunologic Factors; Middle Aged; Plant Poisoning; Suicide, Attempted; Treatment Outcome

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

Topics: Bradycardia; Cardiac Glycosides; Child, Preschool; Digitalis; Emergency Treatment; Female; Humans; Male; Middle Aged; Nerium; Plant Poisoning; Vomiting

Comfrey (Symphytum officinale) leaves resemble those of foxglove (Digitalis purpurea) when the plant is not in bloom and, therefore, cardiac glycoside poisoning may occur when people confuse foxglove with comfrey. We report an outbreak of foxglove leaf poisoning following the use of alleged "comfrey" herbal tea. Nine patients were involved and initially presented with nausea, vomiting, diarrhea and dizziness. Significant cardiotoxicity developed later among the 3 patients who also had mild hyperkalemia. Peak serum digoxin concentration measured by immunoassay was elevated in all patients and ranged from 4.4 ng/mL to 139.5 ng/mL. Patients with severe cardiotoxicity were treated with temporary cardiac pacing. Moreover, 40-80 mg of digoxin-specific antibody therapy was given without any effect. All patients recovered uneventfully. Our report highlights the potential risk of misidentification of herbs; in this case, D. purpurea was mistaken for S. officinale. Physicians should be aware that cardiac glycoside poisoning could arise from such misidentification. Public education about the toxicity of D. purpurea poisoning may reduce the risk of misidentification and subsequent poisoning.

Topics: Antibodies; Digitalis; Digoxin; Disease Outbreaks; Female; Humans; Middle Aged; Plant Poisoning; Potassium

While digitoxicity secondary to therapeutic use is frequent, due to its distinctive appearance and unpleasant taste accidental ingestion of digitalis purpurea (foxglove) is uncommon. This report relates the case of two previously healthy individuals who inadvertently consumed significant quantities of digitalis in its plant form. Both men presented in first-degree atrioventricular block and had digoxin levels of 4.9 μg/litre, but were otherwise stable and made unremarkable recoveries with repeated dose activated charcoal.

Topics: Accidents; Adult; Atrioventricular Block; Diagnosis, Differential; Digitalis; Digoxin; Electrocardiography; Emergency Service, Hospital; Foodborne Diseases; Humans; Male; Middle Aged; Plant Poisoning; Taste

Our environment hosts a vast diversity of venomous and poisonous animals and plants. Clinical toxinology is devoted to understanding, preventing and treating their effects in humans and domestic animals. In Sri Lanka, yellow oleander (Thevetia peruviana, Sinhala 'kaneru'), a widespread and accessible ornamental shrub, is a popular means of self-harm. Its toxic glycosides resemble those of foxglove, against which therapeutic antibodies have been raised. A randomised placebo-controlled trial proved that this treatment effectively reversed kaneru cardiotoxicity. There are strong scientific grounds for the use of activated charcoal, but encouraging results with multiple-dose activated charcoal were not confirmed by a recent more powerful study. Venom of Russell's viper (Daboia siamensis) in Burma (Myanmar) produces lethal effects in human victims. The case of a 17-year-old rice farmer is described with pathophysiological interpretations. During the first 9 days of hospital admission he suffered episodes of shock, coagulopathy, bleeding, acute renal failure, local tissue necrosis, generally increased capillary permeability and acute symptomatic hypoglycaemia with evidence of acute pituitary/adrenal insufficiency. Antivenom rapidly restored haemostatic function but failed to correct other effects of venom toxins incurred during the 3h before he could be treated.

Topics: Adolescent; Animals; Antivenins; Charcoal; Child; Digitalis; Digoxin; Female; Hemorrhage; Humans; Male; Plant Poisoning; Plants, Toxic; Seeds; Snake Bites; Suicide, Attempted; Viper Venoms

Topics: Anion Exchange Resins; Cholestyramine Resin; Colestipol; Digitalis; Digitoxin; Humans; Plant Poisoning

Topics: Arrhythmias, Cardiac; Digitalis; Electrocardiography; Humans; Plant Poisoning

Topics: Bradycardia; Diagnosis, Differential; Digitalis; Digitoxin; Digoxin; Electrocardiography; Female; Humans; Middle Aged; Nausea; Plant Poisoning; Syncope; Vomiting

Two miniature Shetland ponies showing clinical signs of Digitalis purpurea (foxglove) poisoning were examined. One animal died shortly afterwards, but the second was treated successfully with the anti-arrhythmic agent, phenytoin, and was discharged after 16 days.

Topics: Animals; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Digitalis; Female; Horse Diseases; Horses; Phenytoin; Plant Poisoning; Plants, Medicinal; Plants, Toxic

Leaves or fruit from 14 plants considered to be toxic to pet birds were administered by gavage to 15 pairs of canaries (Serinus canaria). Each bird was given 0.12 to 0.70 g of plant material. One pair served as a control and was given distilled water. The plant materials were flash-frozen in liquid nitrogen, pulverized, and resuspended in deionized water for administration. Of the plants tested, 5 (oleander, lupine, foxglove, yew leaves, and dieffenbachia) were considered highly toxic and were associated with acute death of birds. The remaining plant samples caused no, or only transient, clinical illness.

Topics: Animals; Bird Diseases; Canaries; Digitalis; Female; Housing, Animal; Plant Poisoning; Plants, Medicinal; Plants, Toxic

Topics: Animals; Cattle; Cattle Diseases; Digitalis; Female; Plant Poisoning; Plants, Medicinal; Plants, Toxic

Topics: Animals; Digitalis; Dog Diseases; Dogs; Plant Poisoning; Plants, Medicinal; Plants, Toxic

This article focuses on some of the more common dangerous plant and mushroom ingestions, discussing toxic components, early symptoms, and treatment. Among the plants considered are oleander, foxglove, hemlock, dieffenbachia, and Amanita phalloides. Details concerning recognition of toxic species are intentionally omitted in an effort to avoid potentially dangerous errors in identification.

Topics: Coprinus; Digitalis; Emergencies; Emetics; Gastric Lavage; Humans; Mushroom Poisoning; Plant Poisoning; Plants, Medicinal; Plants, Toxic; Ricinus communis

Topics: Child; Digitalis; Digitoxin; Heart Block; Humans; Male; Pica; Plant Poisoning; Plants, Medicinal; Plants, Toxic

Topics: Adult; Arrhythmias, Cardiac; Digitalis; Digitoxin; Humans; Male; Plant Poisoning; Plants, Medicinal; Plants, Toxic

Herbal teas occasionally produce toxic reactions. Unwitting use of the foxglove plant for brewing tea resulted in cardiac glycoside toxicity in an otherwise healthy man. Potentially toxic plants are omnipresent whereas herbal tea imbibing has had an enhanced popularity. Physicians will have increasing contact with patients who have inadvertently poisoned themselves with such concoctions.

Topics: Aged; Beverages; Digitalis; Digitalis Glycosides; Humans; Male; Phytotherapy; Plant Poisoning; Plants, Medicinal; Plants, Toxic

Topics: Digitalis; Heart Block; Humans; Male; Middle Aged; Plant Poisoning; Plants, Medicinal; Plants, Toxic

A series of unexpected deaths and unthriftiness was encountered in red deer at Glensaugh Deer Farm, Kincardineshire, Scotland, in the autumn and winter of 1975--76. Occurrence and gross post mortem findings suggested a common etiology but microbiological, helminthological and histological examinations indicated that the syndrome was not of infectious or parasitic origin. Some of the lesions suggested an irritant poison. Foxglove plants were found in the pasture and their poisonous potential seemed to fit the post mortem findings and clinical signs. The diagnosis was confirmed by chemical analysis of tissues and botanical examination of rumen contents, and a similar fatality was produced in a penned red deer by test dosing with powdered foxglove leaves. Possible control and treatment are discussed. It is concluded that foxglove poisoning may be an occasional hazard in the husbanding of red deer. The history, clinical syndrome and gross post mortem findings may be sufficiently characteristic to allow a provisional diagnosis to be made in the field.

Topics: Animals; Deer; Digitalis; Plant Poisoning; Plants, Medicinal; Plants, Toxic

Topics: Animals; Cattle; Digitalis; Plant Poisoning; Plants, Medicinal; Plants, Toxic; Sheep; Sheep Diseases

Topics: Alkaloids; Cephaelis; Child; Cyanides; Digitalis Glycosides; Digitoxin; Hazardous Substances; Humans; Infant; Ipecac; Plant Poisoning; Plants, Toxic; Toxicology

Topics: Apocynaceae; Digitalis; Digitalis Glycosides; Electrocardiography; Humans; Hypoglycemia; India; Plant Poisoning; Toxicology