Presentation
Three patients presented a digital cup on the electrocardiogram. In our series, in digoxin overdosage, 3 patients with electrical signs of digoxin overdosage have all 3 digoxin-beta-blockers. [ncbi.nlm.nih.gov]
Gastrointestinal
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Vomiting
A previously well woman aged 63 years presents to the emergency department with vomiting, palpitations and 3 presyncopal episodes. [ncbi.nlm.nih.gov]
heart palpitations, anorexia, vomiting, and diarrhea) that may result from their accumulation in the body. common foxgloveCommon foxglove (Digitalis purpurea).Kurt Stueber/www.BioLib.de Digitalis was first prescribed by English physician and botanist [britannica.com]
Causing vomiting. Other conditions. More evidence is needed to rate the effectiveness of foxglove for these uses. Foxglove contains chemicals from which the prescription medication digoxin (Lanoxin) is made. [emedicinehealth.com]
Symptoms may include gastrointestinal disturbances and pain, severe headache, nausea, vomiting, diarrhea, irregular pulse, and yellow vision ..." "European Resuscitation Council".[verification needed] Lee Lopez, Orchid (2011). [en.wikipedia.org]
Methods to cause vomiting are usually not done because vomiting can worsen slow heart rhythms. In severe cases, medicines called digoxin-specific antibodies may be prescribed. Dialysis may be needed to reduce the level of digitalis in the body. [pennstatehershey.adam.com]
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Nausea
If you are given too much digoxin you may lose your appetite or develop nausea (feeling sick), headache or blurred / coloured vision. [heartfailurematters.org]
Symptoms may include gastrointestinal disturbances and pain, severe headache, nausea, vomiting, diarrhea, irregular pulse, and yellow vision ..." "European Resuscitation Council".[verification needed] Lee Lopez, Orchid (2011). [en.wikipedia.org]
Signs of toxicity include nausea, vomiting, and an irregular heartbeat. To prevent DT, monitor your intake of digitalis to make sure you’re not taking too much of the medication. [healthline.com]
Smith et al. (1982) describe the symptoms of digoxin and digitoxin toxicity, including nausea and severe vomiting. Many people develop hyperkalemia. [web.archive.org]
It is sometimes impossible to give enough digitalis to slow down a tachycardia without inducing nausea, vomiting, pulsus bigeminus, or other signs of intoxication. [jamanetwork.com]
Cardiovascular
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Tachycardia
atrial tachycardia with block, and multifocal tachycardia were observed. [ncbi.nlm.nih.gov]
Bidirectional ventricular tachycardia Bidirectional ventricular tachycardia is particularly characteristic of severe digitalis toxicity and results from alterations in intraventricular conduction, junctional tachycardia with aberrant intraventricular [emedicine.com]
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Slow Pulse
pulse, tremors, unusual color visions, convulsions Toxic Principle: Cardiac or steroid glycosides Severity: HIGHLY TOXIC, MAY BE FATAL IF EATEN! [plants.ces.ncsu.edu]
According to Withering, "the Foxglove, when given in large and quickly-repeated doses, occasions sickness, vomiting, purging, giddiness, confused vision, objects appearing green or yellow; increased secretion of urine...slow pulse, even as slow as 35 [aaas.org]
Signs of foxglove poisoning include stomach upset, small eye pupils, blurred vision, strong slow pulse, nausea, vomiting, dizziness, excessive urination, fatigue, muscle weakness and tremors, stupor, confusion, convulsions, abnormal heartbeats, and death [emedicinehealth.com]
Depending on the severity of the toxicosis the victim may later suffer irregular and slow pulse, tremors, various cerebral disturbances, especially of a visual nature (unusual color visions with objects appearing yellowish to green, and blue halos around [chemeurope.com]
Musculoskeletal
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Muscle Weakness
Signs of foxglove poisoning include stomach upset, small eye pupils, blurred vision, strong slow pulse, nausea, vomiting, dizziness, excessive urination, fatigue, muscle weakness and tremors, stupor, confusion, convulsions, abnormal heartbeats, and death [emedicinehealth.com]
CNS headache Malaise confusion muscle weakness delirium drowsiness parasthesia hallucination 15. VISUAL changes halos blurred vision amblyopia Yellow vision scotoma diplopia 16. [slideshare.net]
Eyes
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Blurred Vision
Signs of foxglove poisoning include stomach upset, small eye pupils, blurred vision, strong slow pulse, nausea, vomiting, dizziness, excessive urination, fatigue, muscle weakness and tremors, stupor, confusion, convulsions, abnormal heartbeats, and death [emedicinehealth.com]
Symptoms These are symptoms of digitalis toxicity: Confusion Irregular pulse Loss of appetite Nausea, vomiting, diarrhea Fast heartbeat Vision changes (unusual), including blind spots, blurred vision, changes in how colors look, or seeing spots Other [pennstatehershey.adam.com]
Inform your doctor if you develop: confusion, visual disturbances ( blurred vision or yellow/green halos around objects), fast/slow/irregular heartbeat, skin rash, breast enlargement, severe stomach upset. [medicinenet.com]
VISUAL changes halos blurred vision amblyopia Yellow vision scotoma diplopia 16. [slideshare.net]
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Diplopia
VISUAL changes halos blurred vision amblyopia Yellow vision scotoma diplopia 16. [slideshare.net]
Psychiatrical
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Psychiatric Manifestation
Psychiatric manifestations, from calm disorientation to violent psychosis, tend to occur more often in elderly patients and may be the earliest or only sign of digitalis toxicity. [ncbi.nlm.nih.gov]
Neurologic
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Confusion
Borage, during the non-flowering seasons, can be easily confused with foxglove (Digitalis spp.), and this was the main clue to suspect poisoning. Both patients were given DigiFab , a sheep antibody fragment with high affinity for digoxin. [ncbi.nlm.nih.gov]
Not to be confused with: common comfrey (Symphytum officinale). Comfrey could be mistaken for foxglove when not in flower, as the leaves are similar. [woodlandtrust.org.uk]
CNS headache Malaise confusion muscle weakness delirium drowsiness parasthesia hallucination 15. VISUAL changes halos blurred vision amblyopia Yellow vision scotoma diplopia 16. [slideshare.net]
Acute poisoning presents with the common initial manifestations of nausea and vomiting, cardiovascular manifestations (bradycardia, heart block and a variety of dysrhythmias), central nervous system manifestations (lethargy, confusion and weakness) and [orpha.net]
[…] late summer Exposure: Partial shade Soil: Moist, well-drained soil Regions: Mountains, Piedmont, Coastal Plain Family: Scrophulariaceae Origin: Europe Poison Part: Leaves, flowers, seeds; overdoses of the drug digitalis Poison Delivery Mode: Ingestion, confusion [plants.ces.ncsu.edu]
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Cognitive Impairment
This finding was confirmed after correction for dose of digitalis, age, physical and cognitive impairment, atrial fibrillation, chronic obstructive pulmonary disease, glomerular filtration rate, and use of amiodarone, beta-blockers, nondihydropyridine [ncbi.nlm.nih.gov]
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Dysarthria
The digitalis therapy induced slight improvement of severe dysarthria and cognitive dysfunction in the two older patients. [ncbi.nlm.nih.gov]
Workup
(See Presentation and Workup .) During the early 20th century, as a result of the work of Cushny, Mackenzie, Lewis, and others, the drug was gradually recognized as specific for treatment of atrial fibrillation. [emedicine.com]
(See Presentation and Workup.) During the early 20th century, as a result of the work of Cushny, Mackenzie, Lewis, and others, the drug was gradually recognized as specific for treatment of atrial fibrillation. [emedicine.medscape.com]
Rhythm
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Atrioventricular Dissociation
After ROSC was achieved, the electrocardiogram (ECG) showed an idio-ventricular rhythm with atrioventricular dissociation. A transcutaneous pacing was hence applied and the patient was administered with isoproterenol. [ncbi.nlm.nih.gov]
Hypertrophy
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Ventricular Hypertrophy
Abstract Patients with chronic renal failure develop a cardiomyopathy characterized by marked diastolic dysfunction and left ventricular hypertrophy. [ncbi.nlm.nih.gov]
Treatment
It is suggested that patients with PMD may respond to symptomatic treatment modulating nerve conduction. [ncbi.nlm.nih.gov]
Prognosis
Outlook (Prognosis) How well a person does depends on the severity of the toxicity and if it has caused an irregular heart rhythm. [pennstatehershey.adam.com]
One study suggests that adolescents are more susceptible to digoxin on a mg/kg basis. [18] Prognosis Prognosis in digitalis toxicity worsens with increasing age and associated comorbid conditions. [emedicine.com]
It has an ominous prognosis due to possible degeneration to ventricular fibrillation and sudden death. [revespcardiol.org]
Etiology
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]
(See Etiology and Epidemiology .) Cardiac glycosides are found in certain flowering plants, such as oleander and lily-of-the-valley. [emedicine.com]
(See Etiology and Epidemiology.) Cardiac glycosides are found in certain flowering plants, such as oleander and lily-of-the-valley. [emedicine.medscape.com]
Epidemiology
We performed this systematic review of available epidemiological studies to clarify the association between digitalis use and the risk of breast cancer. [ncbi.nlm.nih.gov]
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]
(See Etiology and Epidemiology .) Cardiac glycosides are found in certain flowering plants, such as oleander and lily-of-the-valley. [emedicine.com]
(See Etiology and Epidemiology.) Cardiac glycosides are found in certain flowering plants, such as oleander and lily-of-the-valley. [emedicine.medscape.com]
Pathophysiology
This Review focuses on the role of endogenous cardiotonic steroids in the pathophysiology of essential hypertension, congestive heart failure, end-stage renal disease and pre-eclampsia. [ncbi.nlm.nih.gov]
The Holter/signal averaging electrocardiogram substudy examined the pathophysiology of sudden cardiac death. [clinicaltrials.gov]
Pathophysiology More than 200 naturally occurring cardiac glycosides have been identified. These bind to a site on the cell membrane, producing reversible inhibition of the sodium (Na )-potassium (K )-adenosine triphosphatase (ATPase) pump. [emedicine.medscape.com]
Congestive Heart Failure: Pathophysiology, Diagnosis and Comprehensive Approach to Therapy. Baltimore, Md: Williams & Wilkins. In press.Google Scholar 15 Cheng JWM, Charland SL, Shaw LM, Kobrin S, Goldfarb S, Stanek EJ, Spinler SA. [ahajournals.org]
Prevention
DESIGN: In the Stroke Prevention using an ORal Thrombin Inhibitor in atrial Fibrillation (SPORTIF) III and V studies, 7329 patients with AF at moderate-to-high risk were randomised to preventive treatment of thromboembolism, either with warfarin or the [ncbi.nlm.nih.gov]