digoxin and Vomiting

Topics: Administration, Oral; Adult; Digoxin; Dose-Response Relationship, Drug; Electrocardiography; Erythrocytes; Heart Rate; Humans; Male; Metabolic Clearance Rate; Methods; Nausea; Radioimmunoassay; Rubidium; Statistics as Topic; Time Factors; Vomiting

Topics: Adult; Aged; Clinical Trials as Topic; Digoxin; Drug Combinations; Drug Evaluation; Feeding and Eating Disorders; Female; Headache; Heart Failure; Humans; Male; Middle Aged; Nausea; Vertigo; Vision Disorders; Vomiting

Topics: Acute Kidney Injury; Aged, 80 and over; Atrial Fibrillation; Confusion; Delirium; Diagnosis, Differential; Digoxin; Electrocardiography; Female; Heart Failure; Humans; Immunoglobulin Fab Fragments; Lung Diseases; Medically Uninsured; Nausea; Poisoning; Radiography, Thoracic; Vomiting

Serum digoxin levels have limited utility for determining digoxin toxicity in adults. Paediatric data assessing the utility of monitoring serum digoxin concentration are scarce. We sought to determine whether serum digoxin concentrations are associated with signs and symptoms of digoxin toxicity in children.. We carried out a retrospective review of patients 2 ng/ml).. There were 87 patients who met study criteria (male 46%, mean age 8.4 years). CHD was present in 67.8% and electrocardiograms were performed in 72.4% of the patients. The most common indication for digoxin toxicity was heart failure symptoms (61.5%). Toxic serum digoxin concentrations were present in 6.9% of patients (mean 2.6 ng/ml). Symptoms associated with digoxin toxicity occurred in 48.4%, with nausea/vomiting as the most common symptom (36.4%), followed by tachycardia (29.5%). Compared with those without toxic serum digoxin concentrations, significantly more patients with toxic serum digoxin concentrations were female (p=0.02). The presence of electrocardiogram abnormalities and/or signs and symptoms of digoxin toxicity was not significantly different between patients with and without serum digoxin concentrations (p>0.05).. Serum digoxin concentrations in children are not strongly associated with signs and symptoms of digoxin toxicity.

Topics: Adolescent; Age Factors; Arrhythmias, Cardiac; Cardiovascular Agents; Child; Child, Preschool; Digoxin; Electrocardiography; Female; Heart Failure; Humans; Infant; Male; Nausea; Retrospective Studies; Texas; 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: Acute Kidney Injury; Aged; Agglutinins; Anti-Arrhythmia Agents; Atrial Fibrillation; Bradycardia; Digoxin; Dosage Forms; Dose-Response Relationship, Drug; Drug-Related Side Effects and Adverse Reactions; Electrocardiography; Fatigue; Humans; Male; Treatment Outcome; Vision Disorders; Vomiting

Digitalis glycosides are among the oldest drugs used in cardiology. Nowadays, due to the limited indications for their use (advanced heart failure, usually concomitant with atrial fibrillation), cases of poisoning induced by this class of drugs are rarely observed. Digoxin produces a positive inotropic and bathmotropic effect on the heart, but has a negative chronotropic and dromotropic effect. Cardiac glycosides have a narrow therapeutic window, so digitalis treatment can easily lead to symptoms of overdose. In patients taking digoxin, the drug therapeutic level should be maintained at 1-2 ng/ml; the toxic effects occur at concentrations > 2.8 ng/ml and are mainly related to disturbances of cardiac function and of the circulatory system, as well as gastrointestinal symptoms and CNS disturbances. We present, a 45-years-old patient who was hospitalized following the ingestion with suicidal intent of 100 0.25 mg tablets of digoxin. In spite of rapidly applied gastric irrigation and administration of activated charcoal, the drug level in the patient's blood was estimated at 12.0 ng/ml. During her stay on the ward, typical symptoms of severe poisoning were observed: from gastric symptoms (severe nausea, vomiting) to numerous severe arrhythmias and conduction disturbances. Type I, II and III AV blocks were detected, as well as numerous ventricular and supraventricular extrasystoles. These conduction disorders required the use of temporary endocardial pacing. Due to the unavailability of specific antidotes (antidigitalis antibodies) and lack of efficient methods of extracorporeal elimination of the drug, symptomatic treatment comprising the correction of electrolyte disturbances and heart rate control remains the most effective.

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Digoxin; Electrocardiography; Female; Fluid Therapy; Humans; Middle Aged; Nausea; Suicide, Attempted; Vomiting; Water-Electrolyte Imbalance

An 87-year-old male, prescribed digoxin and furosemide for congestive heart failure and Alzheimer disease, had dehydration and anemia due to poor food intake and hemorrhagic cystitis. Repeated vomiting due to an upper respiratory infection caused disturbance of consciousness and hypotension. The patient was admitted to hospital and diagnosed with digoxin intoxication and hypernatremia. The serum sodium (Na(+)) level was corrected, but the patient died 4 days after admission following uncontrollable seizure. A histologic examination after an autopsy revealed characteristic findings of central pontine myelinolysis (CPM). This is the first autopsy report on CPM triggered by vomiting in association with digoxin administration.

Topics: Aged, 80 and over; Brain; Cardiotonic Agents; Digoxin; Fatal Outcome; Forensic Pathology; Humans; Hypernatremia; Hypokalemia; Male; Myelinolysis, Central Pontine; Respiratory Tract Infections; Seizures; Staining and Labeling; Vomiting

In this article is presented the case of development of glycoside intoxication at patient of 26 years old, who has congenital heart disease (Ebstein's anomaly). He also has duodenal ulcer and gastric erosions, associated with Helicobacter Pylori, that were diagnosed for the first time. The clinical observation reflects the necessity of differential diagnostics between glycoside intoxication and manifestation of duodenal ulcer.

Topics: Adult; Cardiotonic Agents; Digoxin; Duodenal Ulcer; Ebstein Anomaly; Helicobacter Infections; Helicobacter pylori; Humans; Male; Nausea; Stomach Diseases; Vomiting

We report a case of digoxin-like toxicity because of ingestion of foraged plants. This patient presented with nausea, vomiting, bradycardia, and hypotension after ingesting Veratrum viride (false hellebore). The patient's serum specimen demonstrated a positive digoxin level (0.38 ng/mL) measured by a clinical tubidimetric immunoassay. We hypothesize that steroidal alkaloid compounds contained in V. viride cross-react with the Multigent Digoxin immunoassay reagent antibodies.. Plant extracts from V. viride demonstrated cross-reactivity to Multigent reagent antibodies but did not bind therapeutic DigiFab antibodies. Gas chromatography/mass spectrometry analyses identified several steroidal alkaloid compounds present in the V. viride extracts: jervine, ribigirvine, solanidine, and veratraman.. This study indicates that compounds extracted from V. viride can cross-react with a clinical Digoxin immunoassay. Yet these extracts did not bind DigiFab antibody fragments used for therapeutic intervention. Providers should not unnecessarily administer DigiFab fragments as an antidote in symptomatic V. viride toxic patients.

Topics: Biological Assay; Bradycardia; Chemistry, Clinical; Cross Reactions; Digoxin; Eating; Humans; Hypotension; Immunoassay; Immunoglobulin Fab Fragments; Nausea; Plant Extracts; Plants; Veratrum; Veratrum Alkaloids; Vomiting

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

Acute digitalis overdosage is characterized by high electric instability, its mortality may reach 10-15 percent even nowadays.. To detect the possible risk factors which might predict severe intoxication.. Data of 50 patients treated at authors' department with acute digoxin poisoning over the past 8 years could be retrospectively evaluated. Cases were classified according to the Poison Severity Score (PSS). The following parameters were taken into consideration: age, sex, diseases influencing the severity of intoxication, dose of the drug, heart frequency, serum potassium and digoxin levels and vomiting. For statistical analysis a Kruskal-Wallis test and a chance-quotient calculation was applied.. From 50 patients 30 were mild (PSS 1, 2), 20 were severely poisoned, which subgroup included 8 deaths (PSS 4) and 12 patients who recovered (PSS 3). Based on Kruskal-Wallis test significant differences were found in the following items: greater number of primary diseases PSS 4 vs other subgroups (p < 0.05); bradycardia PSS 4 vs PSS 2 (p < 0.05) and PSS 3 vs PSS 2 (p < 0.05); hyperkalaemia PSS 3 vs PSS 2 (p < 0.01); elevated serum digoxin level PSS 3 vs PSS 2 (p < 0.05). The risk of severe poisoning (PSS 3-4) was increased in case of hyperkalaemia, bradycardia, vomiting (p < 0.001), and if the patients' age and if the drug dose exceeded 65 years or 10 mg, respectively (p < 0.05).. The predictive risk factors concerning severe acute digoxin poisoning are profuse vomiting, hyperkalaemia and bradycardia. The predictive risk factors of fatal outcome are age over 65 years associated with primary disease, vomiting and bradycardia.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Bradycardia; Cardiotonic Agents; Digoxin; Female; Heart Rate; Humans; Hyperkalemia; Male; Middle Aged; Poisoning; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Vomiting

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 chronically depressed 44-year-old man was rescued by the French medicalised ambulance service four hours after the ingestion of Nerium oleander leaves in a suicide attempt. Cardiotoxicity was evidenced by the presence of bradycardia with mental confusion and vomiting. The patient was empirically treated in the prehospital phase with a single dose of digoxin-specific Fab antibody fragments (Digidot). In spite of this treatment, the patient presented a new episode of important bradycardia (25 b/minute). Thereafter, the patient's rhythm stabilized and neurological signs and vomiting resolved. The patient recovered uneventfully and was discharged from the intensive care unit two days later.

Topics: Adult; Antibodies, Blocking; Bradycardia; Digoxin; Emergency Medical Services; Heart Diseases; Humans; Immunoglobulin Fab Fragments; Male; Nerium; Suicide, Attempted; Vomiting

Topics: Administration, Oral; Adult; Amitriptyline; Bezoars; Charcoal; Digoxin; Emergency Medical Services; Female; Gastric Lavage; Gastroscopy; Hospitalization; Humans; Intensive Care Units; Metoprolol; Psychiatric Department, Hospital; Radiography; Self Administration; Stomach; Vomiting

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

We describe a case of unintentional poisoning from a cardioactive steroid and the subsequent analytic investigation. A 36-year-old woman with no past medical history and taking no conventional medications ingested an herbal preparation marketed for "internal cleansing." Its ingredients were neither known to the patient nor listed on the accompanying literature. The next morning, nausea, vomiting, and weakness developed. In the emergency department, her blood pressure was 110/60 mm Hg, and her pulse rate was 30 beats/min. Her ECG revealed a junctional rhythm at a rate of 30 beats/min and a digitalis effect on the ST segments. After empiric therapy with 10 vials of digoxin-specific Fab (Digibind), her symptoms resolved, and she reverted to a sinus rhythm at a rate of 68 beats/min. Her serum digoxin concentration measured by means of the fluorescence polarization immunoassay (Abbott TDx) was 1.7 ng/mL. Further serum analysis with the Tina Quant digoxin assay, a more digoxin-specific immunoassay, found a concentration of 0.34 ng/mL, and an enzyme immunoassay for digitoxin revealed a concentration of 20 ng/mL (therapeutic range 10 to 30 ng/mL). Serum analysis by means of high-performance liquid chromatography revealed the presence of active digitoxin metabolites; the parent compound was not present. When the diagnosis of cardioactive steroid poisoning is suspected clinically, laboratory analysis can confirm the presence of cardioactive steroids by using immunoassays of varying specificity. An empiric dose of 10 vials of digoxin-specific Fab might be beneficial in patients poisoned with an unknown cardioactive steroid.

Topics: Adult; Bradycardia; Cardiac Glycosides; Dietary Supplements; Digoxin; Electrocardiography; Female; Humans; Hypokalemia; Immunoglobulin Fab Fragments; Muscle Weakness; Nausea; Plant Preparations; Treatment Outcome; Vomiting

Topics: Arrhythmias, Cardiac; Depression; Digoxin; Drug Overdose; Electrocardiography; Enzyme Inhibitors; Humans; Hyperkalemia; Male; Middle Aged; Sodium-Potassium-Exchanging ATPase; Suicide, Attempted; Vomiting

Topics: Aged; Cardiotonic Agents; Confusion; Digoxin; Female; Humans; Hypokalemia; Muscle Weakness; Nursing Assessment; Risk Factors; Tachycardia; Vomiting

An 88-year-old woman was admitted to our hospital because of palpitations, dyspnea, orthopnea and appetite loss. On admission, small crackles were heard on her lower back, and her liver was swollen. Chest rentogenogram showed cardiomegaly (cardio-thoracic ratio 65.5%) and bilateral pleural effusion. Electrocardiograms showed atrial fibrillation with an average heart rate of 95 per minute. Echocardiography revealed mitral stenosis. Because the patient was considered to be suffered from heart failure due to mitral stenosis with atrial fibrillation, furosemide (20 mg per day) and digoxin (0.25 mg per day) was started. After digoxin had been raised to a dose of 0.50 mg per day because of sustained rapid ventricular response on the fourth hospital day, she complained of nausea and vomiting. Serum digoxin concentration was 2.55 ng/ml on the next day, and 1.08 ng/ml 96 hours after discontinuing digoxin. There was no complaint after digoxin was restarted with a dose of 0.05 mg per day. She complained of nausea again on the third day when the digoxin was raised to a dose of 0.083 mg in a blinded study. This observation indicates that digoxin intoxication could occur even in the smaller dose of digoxin than usual in the elderly.

Topics: Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Atrial Fibrillation; Digoxin; Female; Furosemide; Humans; Mitral Valve Stenosis; Nausea; Vomiting

Topics: Cardiac Glycosides; Cardiac Pacing, Artificial; Child; Digoxin; Emergencies; Humans; Immunoglobulin Fab Fragments; Plant Leaves; Plant Poisoning; Plants, Medicinal; Seeds; Sri Lanka; Vomiting

A case of digoxin poisoning following the co-administration of digoxin and clarithromycin in a 28 year old male is described. Since the aetiology of chronic digoxin poisoning is often unclear, clinicians should be aware of the potential drug-drug interaction between digoxin and clarithromycin.

Topics: Adult; Anorexia; Anti-Arrhythmia Agents; Anti-Bacterial Agents; Clarithromycin; Digoxin; Drug Interactions; Drug Therapy, Combination; Emergency Service, Hospital; Humans; Male; Vomiting

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

Contrary to cardiac glycoside poisoning often seen in medical practice, intentional digoxin poisoning is rather rare and its course is serious only if very high doses have been ingested. Ventricular arrhythmias and severe conduction disturbances are the most threatening sings may need the use of antiarrhythmic agents, temporally endocardial stimulation or digoxin specific antibody Fab fragments. The course and the management of digitalis poisoning is described in two young patients (female aged 37 and male aged 26). Before admission to the hospital they were healthy, without any heart problem. Only one patient (female) had short spell of nausea and vomiting as well as green vision phenomenon. This patient developed transitory non-life threatening conduction disturbances (degree and II degree a-v block). The second patient had nausea and vomiting but no serious cardiac symptoms. In both patients very high digoxin plasma levels were found (19.88 ng/ml and 9.63 ng/ml), but no one of them had serious poisoning symptoms and did not require any specific therapy. After 3 (male) and 4 (female) days both patients left the hospital.

Topics: Adult; Arrhythmias, Cardiac; Digoxin; Female; Heart Block; Humans; Male; Nausea; Poisoning; Suicide, Attempted; Vomiting

A retrospective study of 1,269 patients on digoxin was done to determine the relationship between serum digoxin levels of 3.0 ng/ml or higher and clinical toxicity. Of 1,269 patients, 58 (4.6%) had digoxin serum levels of 3.0 ng/ml or higher. Clinical evidence of digoxin toxicity was present in only 11 of these patients and premature blood sampling accounted for the high levels in 10 other nontoxic patients. None of the patients with clinical toxicity died. The other 37 patients tolerated the high digoxin levels without exhibiting toxic effect. Low cardiac output, concomitant use of other drugs, and impaired renal function increased the serum digoxin levels in patients with and without clinical toxicity. Appropriate therapeutic digoxin level monitoring and confirmatory laboratory-clinical relationship may have important influences on these results. Additional work on further definition of "toxic" digoxin levels needs to be performed.

Topics: Adult; Aged; Anti-Arrhythmia Agents; Cardiotonic Agents; Child; Digoxin; Female; Humans; Male; Middle Aged; Nausea; Retrospective Studies; Vomiting

A case is presented of cardiac glycoside poisoning in a 1-year-old patient from the plant Nerium oleander (common oleander). The patient had bradycardia, vomiting, altered level of consciousness, and no history of ingestion. Antibody-based digoxin assays may cross-react with other cardiac glycosides nonquantitatively. Chromatographic techniques can be used in the specific diagnosis.

Topics: Animals; Anti-Arrhythmia Agents; Bradycardia; Cardenolides; Chromatography, High Pressure Liquid; Cross Reactions; Digoxin; False Positive Reactions; Glycosides; Humans; Immunoassay; Infant; Male; Plant Poisoning; Vomiting

Toxicity from toad venom poisoning is similar to digoxin toxicity and carries a high mortality rate. We report on six previously healthy men who developed vomiting and bradycardia after ingesting a purported topical aphrodisiac. Each patient had positive apparent digoxin levels and the first four patients died of cardiac dysrhythmias. The last two patients recovered following treatment with digoxin Fab fragments. We analyzed samples of the purported aphrodisiac and found that it was identical to Chan Su, a Chinese medication made from toad venom. To our knowledge, this is the first reported use of digoxin Fab fragments to treat toad venom poisoning.

Topics: Adolescent; Adult; Amphibian Venoms; Animals; Aphrodisiacs; Bradycardia; Bufanolides; Bufonidae; Bufotenin; Digoxin; Fatal Outcome; Humans; Immunoglobulin Fab Fragments; Male; Materia Medica; Ventricular Fibrillation; Vomiting

Gitaloxin is a digitalis glycoside used for the same indications as digoxin and digitoxin. The successful outcome for a 2 1/2-year-old boy who accidentally ingested 3 mg of gitaloxin (100 times the normal therapeutic dose) is reported. At admission the child presented with irregular heart rhythm. He subsequently started vomiting, even after continuous gastric feeding. Only 48 h after ingestion of gitaloxin he became somnolent and developed bradyarrhythmia. The symptoms disappeared 96 h later; the bradyarrhythmia, however, (second-degree atrioventricular block) decreased progressively only after 120 h. The initial clinical presentation of gitaloxin poisoning may be misleading and careful observation in a pediatric intensive care unit is mandatory. A cross-reaction between the fluorescence polarization immunoassay for digitoxin and the radioimmunoassay for gitaloxin was found and was used as a helpful, but rough, estimate of the severity of gitaloxin poisoning, in the absence of a specific measurement of gitaloxin.

Topics: Bradycardia; Child, Preschool; Critical Care; Digoxin; Electrocardiography; Fluorescence Polarization Immunoassay; Humans; Male; Poisoning; Vomiting

Topics: Aged; Antifungal Agents; Blindness; Cardiotonic Agents; Digoxin; Drug Interactions; Humans; Itraconazole; Male; Vomiting

Digoxin toxicity occurs most commonly among the elderly. While the clinical syndrome of digoxin toxicity is well understood, how toxic manifestations change with age is not known.. We performed secondary analysis of data from a postmarketing surveillance study of patients with life-threatening digoxin toxicity treated with digoxin antibody therapy. Patients receiving long-term maintenance digoxin therapy and aged 55 years or older were divided into four age groups: 55 to 64, 65 to 74, 75 to 84, and 85 years and older (n = 45, 167, 183, and 83, respectively) and compared with regard to presenting manifestations, digoxin dosing, serum potassium and digoxin levels, and renal function.. The prevalence of high-degree atrioventricular block showed an increasing but nonsignificant trend with age (40%, 40%, 42%, and 47%, respectively). Age-related trends in high-degree atrioventricular block were stronger among men than women and even stronger among men with underlying cardiac ischemia. The proportion of subjects with nausea/vomiting as a toxic manifestation did not consistently change with age (42%, 48%, 48%, and 46%, respectively). There were no age-related differences in degree of renal impairment or maintenance dose, but maintenance dose decreased with increasing renal impairment.. Among patients with life-threatening digoxin toxicity, there is no age-related difference in clinical presentation.

Topics: Age Factors; Aged; Aged, 80 and over; Arrhythmias, Cardiac; Digoxin; Female; Heart Block; Humans; Immunoglobulin Fab Fragments; Male; Middle Aged; Nausea; Poisoning; Prevalence; Product Surveillance, Postmarketing; Vomiting

Topics: Aged; Aged, 80 and over; Digoxin; Female; Humans; Nausea; Nursing Assessment; Vomiting

Topics: Bradycardia; Digoxin; Drug Interactions; Erythromycin; Female; Humans; Middle Aged; Nausea; Risk Factors; Vomiting

In seven healthy dogs, digoxin was given as an oral loading dose (0.05 mg/kg/day) on the first day, followed by an oral maintenance dose (0.02 mg/kg/day) during the next 14 days. On the sixth day of digoxin treatment, oral quinidine (200 mg b.i.d.) was added until the tenth day. Plasma concentrations of digoxin and quinidine were measured; in three of the seven dogs ECG and physical signs of digitalis toxicity were evaluated. The average steady state plasma concentration of digoxin increased significantly (P less than 0.01) during quinidine administration (from 1.4 to 2.3 ng/ml). On the days that digoxin was administered without quinidine, none of the dogs vomited nor was anorectic; the PQ-interval increased significantly (P less than 0.01) between 0.01 and 0.03 s. When quinidine was added, vomiting and anorexia occurred but no further increases in the PQ-interval were seen.

Topics: Animals; Appetite Depressants; Digoxin; Dogs; Drug Interactions; Electrocardiography; Quinidine; Vomiting

Nonanesthetized cats of both sexes were given oral digoxin (0.011 mg/kg of body weight) 3 forms: elixir, tablet, and crushed tablet mixed with food. Mean peak plasma concentrations of digoxin were highest with the elixir (1.89 +/- 1.02 ng/ml) and lowest with the crushed tablet mixed with food (0.66 +/- 0.35 ng/ml). Male cats had significantly higher (P less than 0.10) mean plasma digoxin concentrations than did female cats. A 2nd group of nonanesthetized cats of both sexes was given digoxin elixir orally at therapeutic amounts (0.011 mg/kg) once a day for 4 consecutive days. The cumulative effect of digoxin resulted in 62% increase in the mean peak plasma concentration and 231% increase in the 24-hour plasma concentration of digoxin over the 4-day period. Male cats had a significantly (P less than 0.05) higher mean plasma digoxin concentration than did the female cats. Significant changes in the ECG were not recorded. A 3rd group of nonanesthetized cats of both sexes was given a single toxic dose (0.11 mg/kg) of digoxin elixir orally. All cats showed clinical signs of digitalis toxicosis (depression, vomiting, salivation, and anorexia) before ECG changes appeared. Alterations in the ECG were minimal; the most important changes were a slight increase in the PQ interval, an elevated ST segment, and decreased heart rate. Plasma concentrations of digoxin at the time of vomition ranged from 4.45 to 12.12 ng/ml with a mean peak plasma value of 7.37 +/- 3.61 ng/ml. The cats were clinically ill for 48 to 96 hours. A plasma digoxin concentration of 2.3 ng/ml was not toxic.

Topics: Animals; Cat Diseases; Cats; Digoxin; Electrocardiography; Female; Male; Tablets; Vomiting

We compared the effects of quinidine and three alternate antiarrhythmic drugs on serum digoxin concentration in 63 patients before and during administration of quinidine, procainamide, disopyramide, or mexiletine. Quinidine increased digoxin concentration by at least 0.5 nmol/L in 21 of 22 patients: Mean serum digoxin rose from 1.2 nmol/L to 2.4 nmol/L (P less than 0.001). Procainamide, disopyramide, or mexiletine increased serum digoxin by 0.5 nmol/L in one of 41 patients. Anorexia, nausea, and vomiting develop soon after starting quinidine therapy in 10 of the 22 patients who received quinidine but in only five of the 41 patients who received procainamide, disopyramide, or mexiletine (P less than 0.01). Quinidine prolonged the PR intervals from 160 +/- 14 ms to 183 +/- 26 ms, but procainamide, disopyramide, and mexiletine did not change the PR interval (P less than 0.005). In digitalized patients, quinidine increases serum digoxin concentration, increases digoxin's effect on atrioventricular conduction, and produces more adverse gastrointestinal effects than procainamide, disopyramide, or mexiletine.

Topics: Aged; Anorexia; Anti-Arrhythmia Agents; Digoxin; Disopyramide; Drug Interactions; Female; Humans; Male; Mexiletine; Middle Aged; Nausea; Procainamide; Prospective Studies; Quinidine; Vomiting

Topics: Animals; Body Weight; Brain; Cats; Digoxin; Male; Myocardium; Time Factors; Vomiting

The serum digoxin concentration increased in 25 of 27 study patients (93%), and the mean serum digoxin concentration rose from 1.4 ng/ml to 3.2 ng/ml during quinidine therapy. Anorexia, nausea, or vomiting developed in 16 patients (59%) but disappeared in all ten patients for whom the digoxin dose alone was reduced, suggesting that digoxin excess caused these symptoms. Ventricular premature depolarizations developed in three patients after starting quinidine therapy; ventricular tachycardia developed in one patient, and another died suddenly. When starting quinidine therapy in patients who are taking digoxin, the clinical course, ECG, and serum digoxin level should be followed closely.

Topics: Aged; Anorexia; Arrhythmias, Cardiac; Digoxin; Drug Interactions; Female; Humans; Male; Middle Aged; Nausea; Quinidine; Vomiting

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

In 1148 cases the serum digoxin concentration (SDC) was correlated with the extracardiac signs of digitalis intoxication. There is a considerably overlap of SDC levels of patients with and without extracardiac signs of toxicity even though the mean SDC's of these two groups differ significantly. An increasing percentage of clinical intoxicated patients with increasing SDC levels was found at digoxin concentrations of 2.0 ng/ml and higher. At lower SDC levels patients with and without extracardiac signs of digitalis intoxication did not differ significantly in their mean SDC but in mean age and in mean creatinine concentration indicating that at least part of the symptoms in these patients might be due to a more severe illness. We could show that many of the extracardiac signs of digitalis intoxication are also seen in patients with impaired kidney function at low SDC levels and may lead to a wrong diagnosis. The most common complaint in patients with SDC's of 2.0 ng/ml and more is nausea (39.4%), followed by tiredness (30.4%), dizzyness (23.7%), vomiting (23.1%), headache (16.0%), visual disturbances (13,5%), colour (yellow) seeing (6;7%), diarrhea (4.2%) and severe neuro-psychiatric disturbances (3.8%). In patients with digitalis-induced arrhythmias the sequence of symptoms is the same only with a somewhat higher percentage rate. Only about one half of the patients with digitalis-induced arrhythmias and SDC values up to 2.5 ng/ml showed also extracardiac signs of intoxication. Therefore these signs are not to be taken as early symptoms of digitalis intoxication. Divided into subgroups (patients with/without digitalis-induced arrhythmias, patients with SDC values of more/less than 2.0 ng/ml) the patients with and without extracardiac signs of digitalis toxicity are compared with each other in regard to: mean body height and weight, concentration of digoxin, potassium and creatinine, digoxin dosage and mean age. The greatest differences were found between patients with combined cardiac and extracardiac signs of intoxication and patients with neither cardiac nor extracardiac signs of intoxication: These intoxicated patients are of significantly higher mean age and lower body weight, their mean concentration of digoxin and creatinine and the digoxin dosage administered are significantly greater, but there is no significant difference in potassium concentration. An important group of patients, namely the elderly with impaired kidney function, are especially p

Topics: Age Factors; Creatinine; Diarrhea; Digoxin; Electrocardiography; Fatigue; Headache; Humans; Nausea; Vertigo; Vision Disorders; Vomiting

Topics: Atrial Fibrillation; Digoxin; Heart Rate; Humans; Nausea; Radioimmunoassay; Vomiting

Topics: Aged; Creatinine; Digoxin; Female; Heart Block; Hospitalization; Humans; Male; Middle Aged; Nausea; Potassium; Radioimmunoassay; Tachycardia; Time Factors; Urea; Vomiting

Topics: Biopharmaceutics; Digoxin; Humans; Intestinal Absorption; Nausea; Powders; Solubility; Tablets; Vomiting

Topics: Acute Disease; Biological Transport, Active; Digoxin; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Infant, Premature, Diseases; Magnesium; Male; Phenytoin; Poisoning; Potassium; Respiratory Distress Syndrome, Newborn; Sodium; Vomiting

Topics: Acute Disease; Arrhythmias, Cardiac; Bradycardia; Digoxin; Electrocardiography; Humans; Hypercalcemia; Male; Middle Aged; Nausea; Suicide; Vomiting

Topics: Administration, Oral; Aged; Digoxin; Heart Diseases; Humans; Injections, Intramuscular; Middle Aged; Nausea; Vomiting

Topics: Adenosine Triphosphatases; Animals; Arrhythmias, Cardiac; Chemical Phenomena; Chemistry; Digoxin; False Positive Reactions; Humans; Methods; Potassium; Sodium; Solvents; Swine; Tritium; Vomiting

Topics: Administration, Oral; Digoxin; Humans; Nausea; Radioimmunoassay; Radioisotopes; Rubidium; Time Factors; Vomiting

Topics: Administration, Oral; Adult; Age Factors; Aged; Arrhythmias, Cardiac; Coronary Disease; Digoxin; Electrocardiography; Female; Humans; Hypothyroidism; Male; Middle Aged; Nausea; Potassium; Radioimmunoassay; Rheumatic Heart Disease; Urea; Vomiting

Topics: Adult; Digoxin; Dyspnea; Electrocardiography; Endocarditis, Bacterial; Endocarditis, Subacute Bacterial; Female; Humans; Hypotension; Lincomycin; Male; Nausea; Sepsis; Staphylococcal Infections; Vomiting

Topics: Adult; Aged; Digoxin; Female; Heart Diseases; Humans; Male; Middle Aged; Nausea; Vomiting

Topics: Aged; Digoxin; Female; Heart Diseases; Humans; Injections, Intravenous; Intestinal Absorption; 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: Animals; Digitalis; Digoxin; Dogs; Injections, Intramuscular; Plant Extracts; Vomiting

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