digoxin and Abdominal-Pain

Mitral valve prolapse is not commonly on the list of differential diagnosis when a patient presents in the emergency department (ED) in severe distress, presenting with non-specific features such as abdominal pain, tachycardia and dyspnea. A healthy 55-year-old man without significant past medical history arrived in the ED with a unique presentation of a primary mitral valve prolapse with an atrial septal defect uncommon in cardiology literature. Early recognition of mitral valve prolapse in high-risk patients for severe mitral regurgitation or patients with underlying cardiovascular abnormalities such as an atrial septal defect is crucial to prevent morbid outcomes such as sudden cardiac death.

Topics: Abdominal Pain; Anticoagulants; Anxiety; Cardiotonic Agents; Continuous Positive Airway Pressure; Digoxin; Dopamine; Dyspnea; Electrocardiography; Emergencies; Heart Septal Defects, Atrial; Heart Valve Prosthesis Implantation; Humans; Male; Metoprolol; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Prolapse; Treatment Outcome; Warfarin

The aim is to emphasize the importance of extracardiac symptoms of digoxin intoxication in newborns. The most common intoxication symptoms in adults are of cardiac origin, but due to altered symptomatology, digoxin overdose in infants are not always discovered on symptomatic basis. In preterm infants, this is even more pronounced due to diminished digoxin sensitivity. Also, tissue distribution is altered in newborns, which, combined with the need for higher doses in newborns to obtain clinical effect, underscores the need for the utmost care, when newborns receive digoxin treatment to avoid intoxication. We report a case of severe digoxin intoxication in a preterm newborn infant, leading to distinct gastrointestinal symptoms, but only minor cardiac affection. The literature concerning digoxin intoxication and digoxin measurement is reviewed to elucidate the case report. In conclusion, alertness should be drawn to extracardiac symptoms of digoxin intoxication, especially in newborns, and P-Potassium can serve as a predictor and thereby strengthen any given suspicion. Therapeutic drug monitoring should be performed, as soon as digoxin overdose due to the above-mentioned signs is suspected in spite of vague cardiac symptoms.

Topics: Abdominal Pain; Anti-Arrhythmia Agents; Digoxin; Enterocolitis, Necrotizing; Gastrointestinal Tract; Humans; Infant, Newborn; Infant, Premature; Male; Nausea; Tachycardia, Supraventricular; Vomiting

A patient who had recently been started on digoxin developed acute severe right upper quadrant pain shortly after hemodialysis. He underwent an extensive work-up for abdominal pain but all findings were normal. With reduction of digoxin dosage, a substantial relief of pain was achieved. The pain totally resolved when digoxin was discontinued and recurred when it was restarted. Cardiac glycosides may be a cause of abdominal pain in patients undergoing maintenance hemodialysis and this side effect should be considered before costly work-up is performed.

Topics: Abdominal Pain; Diabetic Nephropathies; Digoxin; Dose-Response Relationship, Drug; Heart Failure; Humans; Male; Middle Aged; Renal Dialysis; Time Factors