All but one of the previous reports had presented fewer than 13 cases 2 ; one report of 170 cases included no ECG or biochemical data. 4 The present study of 351 patients is the first to provide this information. [heart.bmj.com]

It is concluded that in patients presenting with gastro-intestinal symptoms, presumably due to poisoning by traditional medicines, cardiac glycoside poisoning should be suspected. [ncbi.nlm.nih.gov]

Improve your interpretation of presenting symptoms with 38 new topics and 40 new images in the Differential Diagnosis section, and optimize patient care with more than 250 new figures and tables. [books.google.com]

• Congestive Heart Failure

  Review Topic QID: 100535 M1 Select Answer to see Preferred Response PREFERRED RESPONSE 3 (M1.CV.111) An 82-year-old male with a history of congestive heart failure presented with new-onset atrial fibrillation. [medbullets.com]

  Description of the problem Digoxin is commonly used for the treatment of atrial fibrillation, especially with co-existing congestive heart failure. [clinicaladvisor.com]

  Crataegus may also regulate heart rhythm in patients with heart failure. There have been clinical trials using Crataegus extracts in patients with Congestive Heart Failure (CHF) showing significant improvements in symptoms. [restorativemedicine.org]

  Michael Gibson, M.S., M.D. [1] Overview Cardiac glycosides are drugs used in the treatment of congestive heart failure and cardiac arrhythmia. These glycosides are found as secondary metabolites in several plants, but also in some animals. [wikidoc.org]

  It is used in modern medicine to increase the force of the systolic contractions and prolong duration of the diastolic phase in congestive heart failure. [poisonousplants.ansci.cornell.edu]

• Fatigue

  Fatigue, malaise, no desire to walk 4. [slideshare.net]

  Neurologic manifestations, such as lethargy, fatigue, confusion, and weakness, are common. Hyperkalemia or hypokalemia can be observed. [clinicaladvisor.com]

  Symptoms of mild to moderate intoxication of cardiac glycoside poisoning based on the drug Digoxin is fatigue, ventricular ectopic beats, bradycardia, and ventricular tachycardia. [restorativemedicine.org]

  Symptoms typically include shortness of breath, excessive fatigue, and leg swelling. [en.wikipedia.org]

• Gastric Lavage

  lavage) Outlook (Prognosis) The greatest risk of death and bad outcomes is seen in young children and older adults. [lutheranhealthcare.org]

• Vomiting

  In acute toxicity, the following may be present: GI symptoms - Usually evolve within minutes to hours, are nonspecific, and include nausea, vomiting, and abdominal pain Neurologic symptoms - Often are nonspecific and include weakness and altered mental [emedicine.medscape.com]

  CASE DETAILS: 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). [ncbi.nlm.nih.gov]

  0 Reply is it oleander flower.. toxic effct can be arythmia, vomiting, tremors 2 Reply oleander also causes muscle twitching ,spasm, lock jaw, dysarthria in addition to cardiac effects 5 Reply oleander poisoning..... it's toxic compounds are oleandrin [dailyrounds.org]

  Signs and Symptoms: In children cardiac glycoside ingestion causes severe abdominal pain, diarrhea, nausea and vomiting. Additional symptoms include lethargy, circumoral flush, dialated pupils, drooling, sweating, shaking, and ashy coloring. [sites.google.com]

  He is started on a medicine and is warned by his physician of the following potential side effects associated with this therapy: nausea, vomiting, confusion, blurry yellow vision, electrolyte abnormalities, and potentially fatal arrhythmia. [medbullets.com]

• Nausea

  CASE DETAILS: 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). [ncbi.nlm.nih.gov]

  In acute toxicity, the following may be present: GI symptoms - Usually evolve within minutes to hours, are nonspecific, and include nausea, vomiting, and abdominal pain Neurologic symptoms - Often are nonspecific and include weakness and altered mental [emedicine.medscape.com]

  Nausea, malaise, and weakness are common findings in chronic digoxin toxicity. [clinicaladvisor.com]

  Signs and Symptoms: In children cardiac glycoside ingestion causes severe abdominal pain, diarrhea, nausea and vomiting. Additional symptoms include lethargy, circumoral flush, dialated pupils, drooling, sweating, shaking, and ashy coloring. [sites.google.com]

  Typical symptoms of cardiac glycoside poisoning are nausea, vomiting, blurry vision, and cardiac arrhythmias. Overdose can quickly become life-threatening and swift treatment is vital. [amboss.com]

• Diarrhea

  GI symptoms are nonspecific and include the following: Anorexia Nausea Vomiting Diarrhea Abdominal pain Weight loss Neurologic symptoms include the following: Confusion Drowsiness Disorientation Delirium Headache Hallucinations Seizures Visual disturbances [emedicine.medscape.com]

  Signs and Symptoms: In children cardiac glycoside ingestion causes severe abdominal pain, diarrhea, nausea and vomiting. Additional symptoms include lethargy, circumoral flush, dialated pupils, drooling, sweating, shaking, and ashy coloring. [sites.google.com]

  Humans General Symptoms of Poisoning: Abdominal Pains Diarrhea Vomiting Notes on Poisoning: Symptoms can include pain in the mouth cavity, abdominal pains, cramps, diarrhea, and an irregular pulse. [cbif.gc.ca]

  […] is for PEAK Premium Subscribers only Sorry, this question is for PEAK Premium Subscribers only (M1.CV.19) A 58-year-old African-American man with a history of congestive heart failure presents to the emergency room with headache, frequent vomiting, diarrhea [medbullets.com]

  One observes: digestive disorders: frequently, anorexia, nausea, vomiting, salivation; more rarely, diarrhea or constipation and stomach pains. neurosensory disorders: frequently, headache, insomnia, sometimes confusions, depression, dizziness, visual [pharmacorama.com]

• Abdominal Pain

  In acute toxicity, the following may be present: GI symptoms - Usually evolve within minutes to hours, are nonspecific, and include nausea, vomiting, and abdominal pain Neurologic symptoms - Often are nonspecific and include weakness and altered mental [emedicine.medscape.com]

  Signs and Symptoms: In children cardiac glycoside ingestion causes severe abdominal pain, diarrhea, nausea and vomiting. Additional symptoms include lethargy, circumoral flush, dialated pupils, drooling, sweating, shaking, and ashy coloring. [sites.google.com]

  Humans General Symptoms of Poisoning: Abdominal Pains Diarrhea Vomiting Notes on Poisoning: Symptoms can include pain in the mouth cavity, abdominal pains, cramps, diarrhea, and an irregular pulse. [cbif.gc.ca]

  pain, and anorexia Visual disturbances Xanthopsia (yellow-tinted vision) Photophobia Blurry vision with a yellow tint and halos Disorientation, weakness Palpitations (due to arrhythmias or AV block) Diagnostics ECG: potentially severe cardiac arrhythmias [amboss.com]

  Acute digoxin toxicity differs significantly from chronic digoxin toxicity Acute digoxin toxicity is likely to cause gastrointestinal symptoms, such as anorexia, nausea, vomiting, and abdominal pain. [clinicaladvisor.com]

• Loss of Appetite

  Eyes, ears, nose, and throat: Blurred vision Halos around objects (yellow, green, white) * Skin: Allergic reaction (See also: Stevens-Johnson syndrome ) Hives Rash Gastrointestinal: Diarrhea Loss of appetite* Nausea Stomach pain Vomiting Heart and blood [lutheranhealthcare.org]

  […] of appetite* Nausea and vomiting Stomach pain HEART AND BLOOD Irregular heartbeat (or slow heartbeat) Shock (extremely low blood pressure) Weakness NERVOUS SYSTEM Confusion Depression* Drowsiness Fainting Hallucinations* Headache Lethargy or weakness [medlineplus.gov]

• Tachycardia

  These dysrhythmias include the following: Tachydysrhythmia, such as atrial tachycardia with block Junctional tachycardia Paroxysmal atrial tachycardia with block Bidirectional ventricular tachycardia More than a single dysrhythmia may be present. [emedicine.medscape.com]

  Death occurs from ventricular fibrillation or tachycardia. [ncbi.nlm.nih.gov]

  Nicotiana spp (tobacco) ingestion, inhalation or transdermal exposure is possible nicotinic syndrome: GI symptoms, sweating, tachycardia, hypotension, tremor, seizures Psychotropic alkaloids, e.g. [lifeinthefastlane.com]

  The clinical symptoms were characterized by nausea, vomiting, salivation, colic, diarrhoea, ventricular tachycardia, dysrhythmia, heart block, ataxia, drowsiness, muscular tremor. [degruyter.com]

• Hypotension

  […] lanata ) Toxins: digitoxin, digoxin Sign and Symptoms: Nausea, vomiting, diarrhea, salivation Oleander ( Nerium oleander, Thevetia peruviana ) Toxins: oleandrin, folinerin, digitoxigenin, nerium Signs and symptoms: Abdominal pain, visual disturbances, hypotension [sites.google.com]

  Nicotiana spp (tobacco) ingestion, inhalation or transdermal exposure is possible nicotinic syndrome: GI symptoms, sweating, tachycardia, hypotension, tremor, seizures Psychotropic alkaloids, e.g. [lifeinthefastlane.com]

  It is also used in the acute setting, particularly where AF occurs in sepsis and is associated with hypotension. The target should be a resting ventricular rate of approximately 90/minute. [patient.info]

  Complications Complications of herbal cardiac glycoside toxicity are secondary to inadequate tissue perfusion caused by dysrhythmia-induced hypotension and include the following: Hypoxic seizures Myocardial ischemia Mortality/morbidity Factors increasing [emedicine.medscape.com]

• Blurred Vision

  Eyes, ears, nose, and throat: Blurred vision Halos around objects (yellow, green, white) * Skin: Allergic reaction (See also: Stevens-Johnson syndrome ) Hives Rash Gastrointestinal: Diarrhea Loss of appetite* Nausea Stomach pain Vomiting Heart and blood [lutheranhealthcare.org]

  EYES, EARS, NOSE, AND THROAT Blurred vision Halos around objects (yellow, green, white)* SKIN Allergic reaction, including possible Stevens-Johnson syndrome (serious rash and difficulty swallowing and breathing) Hives Rash STOMACH AND INTESTINES Diarrhea [medlineplus.gov]

  Features suggestive of toxicity include nausea, vomiting, diarrhoea, dyspnoea, confusion, dizziness, headache, blurred vision and diplopia. See the British National Formulary (BNF) for the full list [ 6 ]. U&Es should be monitored. [patient.info]

• Diplopia

  Features suggestive of toxicity include nausea, vomiting, diarrhoea, dyspnoea, confusion, dizziness, headache, blurred vision and diplopia. See the British National Formulary (BNF) for the full list [ 6 ]. U&Es should be monitored. [patient.info]

• Nocturia

  Nocturia (frequent night-time urination) may occur when fluid from the legs is returned to the bloodstream while lying down at night. [en.wikipedia.org]

• Confusion

  GI symptoms are nonspecific and include the following: Anorexia Nausea Vomiting Diarrhea Abdominal pain Weight loss Neurologic symptoms include the following: Confusion Drowsiness Disorientation Delirium Headache Hallucinations Seizures Visual disturbances [emedicine.medscape.com]

  Annotation do not confuse with CARDIOTONIC AGENTS History note 2008 Public Note 2008 Record number D054715 Persistent link Allowable qualifiers (subheadings) Browse Medical Subject Headings [medvik.cz]

  […] vomiting, diarrhea, salivation Oleander ( Nerium oleander, Thevetia peruviana ) Toxins: oleandrin, folinerin, digitoxigenin, nerium Signs and symptoms: Abdominal pain, visual disturbances, hypotension, bradycardia and heart block, tachydysrhythmias, confusion [sites.google.com]

  He is started on a medicine and is warned by his physician of the following potential side effects associated with this therapy: nausea, vomiting, confusion, blurry yellow vision, electrolyte abnormalities, and potentially fatal arrhythmia. [medbullets.com]

  One observes: digestive disorders: frequently, anorexia, nausea, vomiting, salivation; more rarely, diarrhea or constipation and stomach pains. neurosensory disorders: frequently, headache, insomnia, sometimes confusions, depression, dizziness, visual [pharmacorama.com]

• Headache

  GI symptoms are nonspecific and include the following: Anorexia Nausea Vomiting Diarrhea Abdominal pain Weight loss Neurologic symptoms include the following: Confusion Drowsiness Disorientation Delirium Headache Hallucinations Seizures Visual disturbances [emedicine.medscape.com]

  Questions (6) Sorry, this question is for PEAK Premium Subscribers only Sorry, this question is for PEAK Premium Subscribers only (M1.CV.19) A 58-year-old African-American man with a history of congestive heart failure presents to the emergency room with headache [medbullets.com]

  One observes: digestive disorders: frequently, anorexia, nausea, vomiting, salivation; more rarely, diarrhea or constipation and stomach pains. neurosensory disorders: frequently, headache, insomnia, sometimes confusions, depression, dizziness, visual [pharmacorama.com]

  Not unless blurry vision, diarrhea, vomiting and nausea, disorientation, drowsiness, headaches, red skin rashes, excessive salivation, sudden alterations in your cardiac rhythm and possible death sound like your idea of fun. Oh. [mentalfloss.com]

  […] syndrome ) Hives Rash Gastrointestinal: Diarrhea Loss of appetite* Nausea Stomach pain Vomiting Heart and blood: Irregular heartbeat (or slow heartbeat) Weakness Nervous system: Confusion Depression* Disorientation Drowsiness Fainting Hallucinations* Headache [lutheranhealthcare.org]

• Prolonged PR Interval

  Electrocardiogram revealed inverted P wave in inferior lead and prolonged PR interval (.28 s), with varying degree AV blocks and normal QRS duration [Figure 1] and [Figure 2]. [heartviews.org]

Cheaper and effective medicines are required, in particular for the treatment of yellow oleander poisoning which is problematic in resource poor countries. © 2015 The British Pharmacological Society. [ncbi.nlm.nih.gov]

Because cardenolides from these plants are structurally similar, acute poisonings are managed using similar treatments. [cochrane.org]

Specific Treatment The first priority in treatment is ensuring the patient has an adequate airway and breathing. Patients who are bradycardic can receive atropine 0.5 mg IV, although any response is likely to be transient and minimal. [clinicaladvisor.com]

Digoxin Fab fragment treatment should be given if indicated. Fab Fragment Treatment Sheep-derived digoxin antibody Fab fragments reportedly are effective for some plant cardiac glycosides. [emedicine.medscape.com]

Overdose can quickly become life-threatening and swift treatment is vital. The first-line treatment for cardiac glycoside poisoning is administration of digoxin-specific antibodies. [amboss.com]

As a proof, we can mention the prognosis, benign on the whole, of intoxications in the child and in the adult with normal heart. Thrombo-embolic and infectious complications will of course weigh heavily on the prognosis. [tandfonline.com]

Prognosis The prognosis for acute digoxin toxicity directly correlates with the mortality. [clinicaladvisor.com]

[…] tracing) Fluids by IV (through a vein) Medicine (antidote) to reverse the effects of the overdose Medications to correct electrolyte ( potassium, magnesium ) imbalances Tube through the nose into the stomach to empty the stomach (gastric lavage) Outlook (Prognosis [lutheranhealthcare.org]

(“scooped” or “sagging” ST segments) ↓ QT interval ↑ PR interval Atrial tachycardia with AV block Laboratory studies Serum digoxin concentration (ideally, measure 6 hours after ingestion) Serum electrolyte levels: hyperkalemia (associated with poor prognosis [amboss.com]

People with a VO2 max <10 cc/kg/min have a clearly poorer prognosis. [en.wikipedia.org]

The case can be confirmed if laboratory testing was not performed because either a predominant amount of clinical and nonspecific laboratory evidence of a particular chemical was present or the etiology of the agent is known with 100% certainty. [emergency.cdc.gov]

Cardiac glycoside poisoning Etiology Digoxin overdose (iatrogenic, by nonadherence to prescribed dosages or by ingestion of plants containing cardiac glycosides) Ouabain poisoning Hypokalemia, because digitalis compounds compete with K+ for binding of [amboss.com]

Etiology Exposure to plants containing glycosides can occur through ingestion of sap, berries, leaves, blossoms, or seeds, or of teas brewed from plant parts. Plant extracts also have been intentionally injected. [emedicine.medscape.com]

Alternative diagnosis If an adequate dose of digoxin immune Fab fragments has been administered and there is no change in the hemodynamics, one should consider searching for alternative etiologies. [clinicaladvisor.com]

^ a b c "Cardiac Glycoside Plant Poisoning: Practice Essentials, Pathophysiology, Etiology". 2017-05-05. ^ a b "Pharmacognosy 2|Digital Textbook Library". www.tankonyvtar.hu. [en.wikipedia.org]

Epidemiology In the 1780s, the foxglove plant (from which digoxin is derived) was used in the treatment of congestive heart failure. [clinicaladvisor.com]

Probable : A clinically compatible case in which a high index of suspicion (credible threat or patient history regarding location and time) exists for digitalis exposure, or an epidemiologic link exists between this case and a laboratory-confirmed case [emergency.cdc.gov]

Digitalis purpurea ) Woolly foxglove ( Digitalis lanata ) Ouabain ( Strophanthus gratus ) Lily-of-the-valley ( Convallaria majalis ) Common oleander ( Nerium oleander ) Yellow oleander ( Thevetia peruviana ) Squill or sea onion ( Urginea maritima ) Epidemiology [emedicine.medscape.com]

History and epidemiology". BMJ. 320 (7226): 39–42. doi:10.1136/bmj.320.7226.39. PMC 1117316. PMID 10617530. ^ Hazebroek MR, Moors S, Dennert R, van den Wijngaard A, Krapels I, Hoos M, et al. (September 2015). [en.wikipedia.org]

The pathophysiology that produces cardiotoxicity involves prolonging refractory period in atrioventricular (AV) node, shortening refractory periods in atria and ventricles, and decreasing resting membrane potential (increased excitability). [emedicine.medscape.com]

Pathophysiology Ingested cardioactive steroids (CAS) are approximately 80% bioavailable. However, toxicokinetics depends on multiple factors,... References 1. [link.springer.com]

Pathophysiology Digoxin, like other cardiac glycosides, inhibits the sodium-potassium-ATPase. This inhibition results in a rise in extracellular potassium and a rise in intracellular sodium. [clinicaladvisor.com]

^ a b c "Cardiac Glycoside Plant Poisoning: Practice Essentials, Pathophysiology, Etiology". 2017-05-05. ^ a b "Pharmacognosy 2|Digital Textbook Library". www.tankonyvtar.hu. [en.wikipedia.org]

Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets [books.google.com]

To prevent further absorption, oral administration of activated charcoal is recommended if no contraindications exist. [emedicine.medscape.com]

Cardiac glycosides function by inhibiting the intercellular sodium-potassium pumps to prevent the extrusion of sodium. Raised sodium levels derange the action of the sodium-calcium pump leading to an increased intracellular calcium concentration. [sites.google.com]

remodeling  Hypokalaemia and hypomagnesia – arrhythmia  Enhancement of sympathetic over activity  Aldosterone antagonists help  Uses:  Add-on therapy to ACE inhibitors + other drugs in mild to moderate cases  Retards disease progression and prevents [slideshare.net]

You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week. Take the container with you to the hospital, if possible. [lutheranhealthcare.org]