digitoxin and Vomiting

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

At a time when self-sufficiency and health are becoming increasingly important in society, the chances of intoxications with wild plants are increasing. Foxglove contains poisonous cardiac glycosides such as digoxin, digitoxin and gitoxin. The levels vary greatly and depend on the season and the location of the plants. The "non-digoxin" cardiac glycosides show a limited cross-reaction with the digoxin assay. This means that a low or therapeutic digoxin level does not rule out a severe foxglove intoxication. Due to the long half-life of the different cardiac glycosides, toxic symptoms can be persistent.. A 43-year-old woman arrived at the Emergency Department with persistent vomiting and specific ECG-abnormalities. The day before, she drunk a smoothie made from wild plants picked in the woods. Patient appeared to have mistaken foxglove for common sorrel.. In case of persistent gastrointestinal complaints with specific ECG abnormalities after ingestion of plant material, clinicians should be aware of a foxglove intoxication.

Topics: Adult; Digitalis; Female; Foodborne Diseases; Humans; Vomiting

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

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

Topics: Anti-Arrhythmia Agents; Bradycardia; Diagnosis, Differential; Digitoxin; Dose-Response Relationship, Drug; Electrocardiography; Electrocardiography, Ambulatory; Female; Humans; Middle Aged; Nausea; Signal Processing, Computer-Assisted; Sinus Arrest, Cardiac; Syncope; Vomiting

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

Topics: Adult; Atrioventricular Block; Bradycardia; Comfrey; Digitalis; Digoxin; Dizziness; Electrocardiography; Humans; Male; Nausea; Phytotherapy; Plant Leaves; Vision Disorders; Vomiting

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

Amphibians possess the ability to vomit in response to a variety of stimuli that provoke emesis in mammals. Pharmacological studies have establish that the ejection of gastric contents and the basic mechanism for vomiting have been phylogenetically conserved among these tetrapods. As part of on-going comparative studies on emesis in vertebrates, we previously documented that some postmetamorphic anurans and salamander larvae experience motion-induced emesis when exposed to the provocative stimulus of parabolic aircraft flight. However, more recent experiments suggest that there are strict conditions for inducing emesis in amphibians exposed to parabolic flight and that amphibians are not as sensitive to this stimulus as mammals. Further studies on emesis in lower vertebrates may help us understand the processes that cause emesis in abnormal gravitational regimes.

Topics: Amphibians; Animals; Anura; Apomorphine; Cisplatin; Digitoxin; Emetics; Hypergravity; Ouabain; Reproducibility of Results; Space Flight; Space Motion Sickness; Urodela; Vomiting; Weightlessness

The paper deals with the effects of a glycosidal extract of Digitalis heywoodii, ssp. of Digitalis purpurea L., (Schrophulariaceae) grown in Badajoz (Spain), on isolated cardiac auricle of rabbits, urinary excretion of rats, as well as its emetic effect in pigeons. These effects using vehicle (propylene glycol-ethanol-water, 40:10:50) and digoxin as standards are presented. The extract at concentrations of 20 and 40 microg/ml produced an increase in the contraction force of auricles in a dose-dependent way. At doses of 15 and 30 mg/kg a slight diuretic and natriuretic effect was observed. The active dose range for emesis was 0.5-4 mg/kg and a decrease of the emesis time within 10 min of injection in dose-dependent manner was obtained. The pharmacological activity of the extract is related to gitoxin derivatives (digitalinum verum and strospeside), the most abundant compounds obtained from the leaves of Digitalis purpurea spp. heywoodii.

Topics: Animals; Columbidae; Digitalis; Dose-Response Relationship, Drug; Heart Rate; In Vitro Techniques; Male; Myocardial Contraction; Plant Extracts; Rabbits; Rats; Vomiting

Topics: Adult; Dietary Supplements; Digitalis; Digoxin; Drug Contamination; Female; Heart Block; Humans; Lanatosides; Middle Aged; Plantago; Plants, Medicinal; Plants, Toxic; Vomiting

The ability of three cardiac glycosides, ouabain, digitonin and digitoxin, to induce emesis and their mechanism(s) of action were investigated in Suncus murinus. The intraperitoneal injection of ouabain but not digitonin nor digitoxin caused vomiting in a dose-dependent manner. However, the administration of ouabain into the cerebroventricle did not cause emesis. Ouabain-induced emesis was partly prevented by surgical abdominal vagotomy. Pretreatment with tropisetron, a selective 5-HT3 (5-hydroxytriptamine) receptor antagonist, did not affect the emetic response evoked by ouabain. These results suggest that ouabain exerts emetic effects via peripheral mechanism(s), but 5-HT3 receptors are not involved in the pathway.

Topics: Animals; Antiemetics; Cardiac Glycosides; Digitonin; Digitoxin; Female; Indoles; Injections, Intraperitoneal; Injections, Intraventricular; Male; Ouabain; Receptors, Serotonin; Receptors, Serotonin, 5-HT3; Serotonin Antagonists; Shrews; Tropisetron; Vagotomy; Vomiting

A 65-year-old woman, known to have peptic ulcers, developed nausea and retching. Clinical examination demonstrated pain on pressure in the epigastrium with otherwise normative findings for age. Two gastric ulcers and gastritis with erosions were seen at endoscopy. The patient, who was being treated with digitoxin for heart failure, reported having taken up to four digitoxin tablets (0.07 mg each) daily because she had insomnia. The plasma digitoxin level was between 150 and 160 nmol/l (therapeutic range 17-33 nmol/l), while the ECG showed no signs of digitalis intoxication. Initially the platelet count was 40,000/microliter: there had been no history of thrombocytopenia or symptoms of abnormal haemostasis. Other laboratory tests were within normal limits. After digitoxin had been discontinued, the platelet count rose without further treatment to 373,000/microliter 3 weeks after hospital admission by which time the digitoxin level had fallen to 48.9 nmol/l. The gastrointestinal symptoms regressed completely on treatment with omeprazole (40 mg three times daily for 8 days) and ranitidine (150 mg twice daily).

Topics: Aged; Digitoxin; Drug Overdose; Female; Gastritis; Gastroscopy; Heart Failure; Humans; Nausea; Omeprazole; Platelet Count; Ranitidine; Stomach Ulcer; Thrombocytopenia; Vomiting

Topics: Administration, Oral; Animals; Digitoxin; Digoxin; Dog Diseases; Dogs; Female; Heart Failure; Male; Vomiting

Topics: Ampicillin; Blood; Chemical and Drug Induced Liver Injury; Digitalis; Drug Hypersensitivity; Female; Fever; Furosemide; Humans; Lidocaine; Middle Aged; Myocardial Infarction; Phytotherapy; Plants, Medicinal; Plants, Toxic; Procainamide; Quinidine; Urine; Vomiting

Topics: Aged; Digitalis; Gastrointestinal Diseases; Gastrointestinal Neoplasms; Geriatrics; Hiccup; Humans; Influenza, Human; Metoclopramide; Morphine; Nausea; Plants, Medicinal; Plants, Toxic; Vomiting

Topics: Adolescent; Adult; Alcoholic Beverages; Atrial Fibrillation; Blood Glucose; Blood Pressure Determination; Body Weight; Cough; Diet; Digitoxin; Electric Countershock; Electrocardiography; Emotions; Fatigue; Female; Heart; Humans; Hypnotics and Sedatives; Male; Middle Aged; Pain; Posture; Quinidine; Radiography; Rest; Thyroid Function Tests; Vagus Nerve; Vomiting

Topics: Angina Pectoris; Coronary Disease; Digitalis; Heart Conduction System; Heart Diseases; Humans; Nausea; Plants, Medicinal; Plants, Toxic; Strophanthins; Vomiting

Topics: Animals; Antitoxins; Anura; Birds; Butterflies; Cats; Chemistry Techniques, Analytical; Digitalis; Digitalis Glycosides; Erythrocytes; Guinea Pigs; Heart; Ileum; Insecta; Isoflurophate; Pharmacology; Research; Toxicology; Toxins, Biological; Vomiting

Topics: Adrenergic Agents; Arrhythmias, Cardiac; Atrial Fibrillation; Digitalis; Digoxin; Electrocardiography; Ethanolamines; Geriatrics; Heart Block; Heart Failure; Hypotension; Myocardial Infarction; Nausea; Paresthesia; Sympatholytics; Toxicology; Vertigo; Vomiting

Topics: Antiemetics; Digitalis; Digitalis Glycosides; Humans; Nausea; Toxicology; Vomiting

Topics: Barbiturates; Digitalis; Heart Diseases; Humans; Nausea; Prochlorperazine; Vomiting

Topics: Animals; Digitalis; Digoxin; Dogs; Injections, Intramuscular; Plant Extracts; Vomiting

Topics: Chlorpromazine; Digitalis; Digitalis Glycosides; Drug-Related Side Effects and Adverse Reactions; Emetics; Plant Extracts; Vomiting

Topics: Animals; Apomorphine; Chlorpromazine; Columbidae; Digitalis; Digitalis Glycosides; Vomiting

Topics: Animals; Cardiac Glycosides; Columbidae; Digitalis; Digitalis Glycosides; Digitoxin; Digoxin; Emetics; Glycosides; Humans; Plant Extracts; Vomiting

Topics: Bradycardia; Digitalis; Digitalis Glycosides; Ganglionic Blockers; Procaine; Reflex; Vomiting

Topics: Autonomic Agents; Digitalis; Digitalis Glycosides; Ganglionic Blockers; Muscle Relaxants, Central; Parasympatholytics; Procaine; Vomiting

Topics: Autonomic Agents; Autonomic Nervous System; Bradycardia; Digitalis; Digitalis Glycosides; Diphenhydramine; Neurocirculatory Asthenia; Reflex; Tetraethylammonium; Vomiting

Topics: Digitalis; Humans; Vomiting

Topics: Cardiovascular Agents; Digitalis; Digitalis Glycosides; Dimenhydrinate; Humans; Vomiting

Topics: Aorta; Cardiovascular System; Digitalis; Digitalis Glycosides; Humans; Vomiting