digoxin and Color-Vision-Defects

Topics: Anorexia Nervosa; Color Vision Defects; Digitalis Glycosides; Digitoxin; Digoxin; Eye Manifestations; Fatigue; Humans; Medication Errors; Mental Disorders; Muscular Diseases; Nausea; Neurologic Manifestations; Poisoning; Vision Disorders

BACKGROUND Manifestations of digoxin toxicity vary, such as cardiac disturbances and gastrointestinal symptoms, and most are not specific to digoxin toxicity. We report a case of xanthopsia (yellow vision), a rare and relatively specific manifestation of digoxin toxicity, causing traffic accidents. CASE REPORT A 76-year-old man was admitted to our hospital for treatment of heart failure. He reported that his digoxin dose had been increased from 0.125 mg daily to 0.25 mg daily 3 weeks before admission. His serum digoxin level was 7.3 ng/mL (therapeutic range 0.8 to 2.0). Additional history-taking revealed that he had xanthopsia several days before admission and stopped riding a motorbike because of two traffic accidents. On ophthalmological examination, he had decreased responses on flash, cone, and 30-Hz flicker electroretinograms in both eyes without visual field impairment. Intravenous hydration was initiated and digoxin was withdrawn. Xanthopsia gradually improved along with the decline of serum digoxin levels and disappeared within a week. One month after admission, electroretinography findings were normal. CONCLUSIONS Our case highlights the importance of acknowledging color vision deficiencies due to digoxin toxicity even in the modern era. This condition may increase risk of adverse events because affected patients are less likely to recognize color vision deficiencies.

Topics: Accidents, Traffic; Aged; Color Vision Defects; Digoxin; Electroretinography; Humans; Male

Disturbances of colour vision are a frequently reported sign of digoxin toxicity. The aim of this study was to investigate the incidence of acquired colour vision deficiency in elderly hospitalised patients receiving maintenance digoxin therapy.. 30 patients (mean age 81.3 (SD 6.1) years) receiving digoxin were tested using a battery of colour vision tests (Ishihara, AO Hardy Rand Rittler plates, City tritan test, Lanthony tritan album, and the Farnsworth D15). These were compared to an age matched control group. Serum digoxin concentrations were determined from venous blood samples.. Slight to moderate red-green impairment was found in approximately 20-30% of patients taking digitalis, and approximately 20% showed a severe tritan deficiency. There was no correlation between colour vision impairment and serum digoxin level.. Formal colour vision testing of elderly patients taking digitalis showed a high incidence of colour deficiency, suggesting that impairment of retinal function can occur even at therapeutic drug levels. As a result, colour vision testing in this population would have limited value for the detection of drug toxicity.

Topics: Aged; Aged, 80 and over; Cardiotonic Agents; Color Perception Tests; Color Vision Defects; Digoxin; Female; Humans; Male

67 year old patient with chronic heart failure and persistent atrial fibrillation had overdosed glycosides for several months. The symptoms of gastrointestinal system and nervous system appeared after long term therapy with toxic doses of glycosides. Originally depression was diagnosed based on the central nervous system disturbances. Even though overdose of glycosides was diagnosed the blood serum glycoside level was within the therapeutic limits. Based on the precise analysis of the data, it was concluded that the reason for normal blood serum glycoside level in this case was coexisting hyperthyreosis.

Topics: Aged; Atrial Fibrillation; Color Vision Defects; Depression; Digoxin; Drug Overdose; Heart Failure; Humans; Hyperthyroidism; Male

1. Eighty-one hospital patients receiving digoxin were separated into groups with and without digoxin toxicity using clinical criteria. Serum digoxin, sodium, potassium, calcium, creatinine, magnesium and monocyte magnesium concentrations were compared. 2. Subjects with digoxin toxicity had impaired colour vision (P less than 0.0001, Farnsworth-Munsell 100 hue test) and increased digoxin levels (1.89 (1.56-2.21) vs 1.34 (1.20-1.47) nmol l-1, P less than 0.01) (mean (95% confidence limits], though there was considerable overlap between two groups. 3. Subjects with digoxin toxicity had lower levels of serum magnesium (0.80 (0.76-0.84) vs 0.88 (0.85-0.91) mmol l-1, P less than 0.01) and monocyte magnesium (6.40 (5.65-7.16) vs 8.76 (7.81-9.71) mg g-1 DNA, P less than 0.01), but there were no significant differences in other biochemical parameters. A greater proportion of toxic subjects were receiving concomitant diuretic therapy (20/21 vs 37/60, P less than 0.05). 4. Magnesium deficiency was the most frequently identified significant electrolyte disturbance in relation to digoxin toxicity. In the presence of magnesium deficiency digoxin toxicity developed at relatively low serum digoxin concentrations.

Topics: Adult; Aged; Aged, 80 and over; Color Vision Defects; Digoxin; Electrolytes; Female; Humans; Magnesium; Magnesium Deficiency; Male; Middle Aged

Disturbances in colour vision are a well-reported adverse ocular effect to toxic levels of digoxin. We present a case history of a patient with both colour vision changes and transient visual field defects to therapeutic serum levels of digoxin.

Topics: Adult; Arrhythmias, Cardiac; Color Vision Defects; Digoxin; Female; Humans; Visual Fields

Topics: Aged; Color Perception Tests; Color Vision Defects; Digitoxin; Digoxin; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged

Using the Farnsworth-Munsell 100-hue test, investigations were carried out in 14 patients with subtoxic to toxic serum concentrations of digoxin (greater than 2.0 ng/ml) and 13 patients with subtoxic to toxic serum concentrations of digitoxin (greater than 30 ng/ml), in order to detect color vision deficiencies related to serum levels of digitalis. As compared to the control group (n = 24) the total error scores were significantly increased for both glycosides and all serum level ranges. No evidence was found indicating that digoxin and digitoxin influence color vision differently. The FM 100-hue test indicated definite improvements in the digoxin group within one day of discontinuing the glycosides, while the digitoxin group only started to normalize a week later. The results are discussed, taking the different pharmacokinetics of the two digitalis glycosides into account.

Topics: Aged; Color Perception Tests; Color Vision Defects; Digoxin; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans

Topics: Aged; Color Vision Defects; Digitalis Glycosides; Digitoxin; Digoxin; Female; Glycosides; Humans; Middle Aged

In the Federal Republic of Germany nearly 4 million patients receive cardiac glycosides. Intoxication rates of up to 20% have been reported. About 80% of digoxin-intoxicated patients show generalized color vision deficiencies. Ophthalmologists should pay more attention to color vision disturbances due to digitalis.

Topics: Color Vision Defects; Digitalis Glycosides; Digitoxin; Digoxin; Humans; Intraocular Pressure; Retina; Vision Disorders

Colour vision has been measured, using the Farnsworth-Munsell 100-Hue test, in control subjects and in patients taking digoxin. In 10 patients with digitalis toxicity, of whom only two described symptomatic abnormalities, colour vision was impaired compared with that of both control subjects and non-toxic patients who had been taking digoxin for more than two months. Withdrawal of digoxin from toxic patients led to improved colour vision. Colour vision scores correlated well with (a) log plasma digoxin concentrations, and (b) various measures of the pharmacodynamic effects of cardiac glycosides on cation transport in the patients' own erythrocytes. These results suggest that colour vision assessment may be of use in screening for digitalis toxicity at the bedside and in assessing the degree of digitalis intoxication in an individual patient as an aid to clinical research.

Topics: Adult; Aged; Aging; Color Perception Tests; Color Vision Defects; Digoxin; Erythrocytes; Female; Humans; Middle Aged; Sodium

Topics: Color Vision Defects; Digoxin; Humans

Topics: Adenosine Triphosphatases; Aged; Color Perception Tests; Color Vision Defects; Digitalis Glycosides; Digoxin; Female; Humans; Male; Middle Aged; Poisoning

Topics: Adult; Chloroquine; Color Perception Tests; Color Vision Defects; Digoxin; Eye Diseases; Female; Humans; Indomethacin; Male; Middle Aged; Retina; Thioridazine