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Digoxin

Digoxin Toxicity


Presentation

  • The patient was discharged 6 days after presentation with full neurological recovery.[ncbi.nlm.nih.gov]
  • A focused review of the literature is presented. Health care providers need to be vigilant of this mechanism of drug-drug interaction, which is also relevant to other commonly used cardiovascular drugs.[ncbi.nlm.nih.gov]
  • As in the case presented, the history of an ingestion may not always be obtained initially.[ncbi.nlm.nih.gov]
  • OBJECTIVE: To present a case of digoxin toxicity with normal levels of digoxin and serum potassium, but with severe hypomagnesemia. CASE REPORT: A 66-year-old woman presented with junctional tachycardia and ectopic atrial tachycardia.[ncbi.nlm.nih.gov]
  • Data collected included demographics, presenting complaint, digoxin dose, other medications taken, serum digoxin, potassium and creatinine concentration on presentation and initial and post-digoxin-Fab heart rate. RESULTS: There were 47 referrals.[ncbi.nlm.nih.gov]
Intravenous Administration
  • Rapid intravenous administration of digoxin as a bolus may result in worsening HF through an early predominant vasoconstrictor effect. 36 Isolated Right-Sided Heart Failure Digoxin increases cardiac output and decreases norepinephrine concentration in[doi.org]
  • Intravenous administration is preferred over intramuscular injection as it can lead to severe pain at the injection site.[drugs.com]
  • Intravenous administration provides about 20% more of the drug then when the same dose is given orally.[thecardiologyadvisor.com]
Wound Infection
  • CASE (DESCRIPTION): A 27 year old female with a complex history of congenital heart disease, cardiac surgery, heart failure, and arrhythmias was admitted for a Pseudomonas aeruginosa sternal wound infection and treated with intravenous antibiotics.[ncbi.nlm.nih.gov]
Vomiting
  • This is the first autopsy report on CPM triggered by vomiting in association with digoxin administration. 2009 Elsevier Ireland Ltd. All rights reserved.[ncbi.nlm.nih.gov]
  • […] intracranial hypertension (IIH)-sometimes called pseudotumor cerebri-is a neurologic condition distinguished by any of the following symptoms: headache, increased cerebrospinal fluid pressure, papilledema, vision loss, diplopia, tinnitus, deafness, nausea and vomiting[ncbi.nlm.nih.gov]
  • Abstract A 70-year-old woman with a history of atrial fibrillation, on digoxin, presented with nausea, vomiting, and dizziness two days after initiation of clarithromycin therapy.[ncbi.nlm.nih.gov]
  • Author information 1 Cardiology Department, Broomfield Hospital, Chelmsford, Essex, UK. [email protected] Abstract The authors report about a patient who was admitted after developing nausea, vomiting, change in vision and lethargy.[ncbi.nlm.nih.gov]
  • Abstract A 38-year-old healthy male presented with vomiting and profuse diarrhea, associated with blurry and yellow coloration of the vision (xanthopsia).[ncbi.nlm.nih.gov]
Nausea
  • She presented to clinic with nausea and anorexia within a few days of addition of ciprofloxacin to her current regimen of medications, which included digoxin.[ncbi.nlm.nih.gov]
  • […] intracranial hypertension (IIH)-sometimes called pseudotumor cerebri-is a neurologic condition distinguished by any of the following symptoms: headache, increased cerebrospinal fluid pressure, papilledema, vision loss, diplopia, tinnitus, deafness, nausea[ncbi.nlm.nih.gov]
  • Abstract A 70-year-old woman with a history of atrial fibrillation, on digoxin, presented with nausea, vomiting, and dizziness two days after initiation of clarithromycin therapy.[ncbi.nlm.nih.gov]
  • Author information 1 Cardiology Department, Broomfield Hospital, Chelmsford, Essex, UK. [email protected] Abstract The authors report about a patient who was admitted after developing nausea, vomiting, change in vision and lethargy.[ncbi.nlm.nih.gov]
  • However, treatment with cisplatin may cause serious side effects, such as myelosuppression, nausea, ototoxicity, nephrotoxicity, and cell resistance processes.[ncbi.nlm.nih.gov]
Diarrhea
  • The most common adverse events were rash, diarrhea, nausea, and fatigue. The response rate was 4/20 or 20% with response durations of 2, 4, 6, and 8 months.[ncbi.nlm.nih.gov]
  • Abstract A 38-year-old healthy male presented with vomiting and profuse diarrhea, associated with blurry and yellow coloration of the vision (xanthopsia).[ncbi.nlm.nih.gov]
  • Diarrhea and vomiting are common side effects of digoxin, according to Drugs.com. If these effects persist, you may develop dehydration due to excess loss of fluids in vomit and diarrhea.[livestrong.com]
  • GI: Anorexia, nausea, vomiting, diarrhea. Other: Diaphoresis, recurrent malaise, dysphagia.[robholland.com]
  • Common side effects may include: nausea, diarrhea ; feeling weak or dizzy; headache , weakness, anxiety , depression ; or rash . This is not a complete list of side effects and others may occur.[emedicinehealth.com]
Slow Pulse
  • Is a slow pulse a reliable sign of digitalis toxicity? Lancet. 1978; 2:1340-2. 224. Seller RH, Cangiano J, Kim KE et al. Digitalis toxicity and hypomagnesemia. Am Heart J . 1970; 79:57-68. 225. Shapiro W.[drugs.com]
  • Is a slow pulse a reliable sign of digitalis toxicity? Lancet. 1978; 2:1340-2. 224. Seller RH, Cangiano J, Kim KE et al. Digitalis toxicity and hypomagnesemia. Am Heart J . 1970; 79:57-68. [PubMed 5410283] 225. Shapiro W.[web.archive.org]
Visual Hallucination
  • Over the following 2-3 weeks she developed nausea, vomiting and dysphagia, snowy and blurry vision, photopsia, dyschromatopsia, aggravated pre-existing formed visual hallucinations and proprioceptive illusions.[ncbi.nlm.nih.gov]
  • Hallucinations caused by digitalis have been reported in the American medical literature since 1901. 1 Recently, three cases were reported in which true formed visual hallucinations were the isolated symptom of digitalis intoxication. 2 We report a case[jamanetwork.com]
  • Formed visual hallucinations as digitalis toxicity. Ann Intern Med . 1979; 91:865-6. 363. Massaro FJ, Moulton JS, Linkewich JA et al. Scotomas secondary to digoxin intoxication. Drug Intell Clin Pharm . 1983; 17:368-70. 364.[drugs.com]
  • Formed visual hallucinations as digitalis toxicity. Ann Intern Med . 1979; 91:865-6. [IDIS 106717] [PubMed 517886] 363. Massaro FJ, Moulton JS, Linkewich JA et al. Scotomas secondary to digoxin intoxication. Drug Intell Clin Pharm . 1983; 17:368-70.[web.archive.org]

Workup

  • Laboratory workup was unremarkable, except for hyperkalemia (K 5.2 mEq/L) and mildly elevated troponin level 0.11 ng/mL (cut-off value 0.08). An electrocardiogram showed sinus bradycardia with deep scooping of the T waves.[ncbi.nlm.nih.gov]
Potassium Increased
  • Potassium levels: Low blood levels of potassium increase the risk of overdose with digoxin.[medbroadcast.com]
  • Specifically, digoxin inhibits sodium-potassium ATPase, the enzyme controlling egress and ingress of cellular sodium and potassium.[thecardiologyadvisor.com]
Short QT Interval
  • The short QT interval, the “sagging” appearance in the inferior leads and the lack of voltage criteria for LVH indicates that this is digoxin effect rather than LVH.[lifeinthefastlane.com]
Third Degree Atrioventricular Block
  • degree atrioventricular block unless a functioning pacemaker is present.[doi.org]
Prominent U Wave
  • The terminal positive deflection may be peaked, or have a prominent U wave superimposed upon it.[lifeinthefastlane.com]
J-Point Depression
  • J point depression (usually in leads with tall R waves).[lifeinthefastlane.com]
  • Clinical significance of the digoxine effect In patients with therapeutic levels of digoxine levels, the sagging type ST segment depression starts from the isoelectric line and there is no J point depression.[metealpaslan.com]

Treatment

  • Cisplatin and other platinum-containing drugs have played a crucial role in anticancer treatments for over 30 years.[ncbi.nlm.nih.gov]
  • Her, our data show that digoxin treatment significantly inhibits leukemia cell viability. In addition, digoxin treatment significantly induced apoptosis and G2/M cell cycle arrest in leukemia cells.[ncbi.nlm.nih.gov]
  • The parameters of the electrocardiogram were not altered before and after treatment with digoxin alone.[ncbi.nlm.nih.gov]
  • These are those patients who have pharmacokinetic monitoring of chronic treatment with digoxin.[ncbi.nlm.nih.gov]
  • The majority (78%) of DIF was administered on days 1 and 2 of the hospitalization; 10% received treatment after day 7. Digoxin was used after DIF administration in 14% of cases.[ncbi.nlm.nih.gov]

Prognosis

  • BACKGROUND: Neonatal survival and prognosis are closely linked with development of hydrops in cases of sustained fetal tachycardia. Several antiarrhythmic medications are available for conversion to sinus rhythm.[ncbi.nlm.nih.gov]
  • Our goal was to determine the effect of beta-blockers on the prognosis of patients hospitalized for decompensated HF who receive digoxin therapy at discharge.[ncbi.nlm.nih.gov]
  • Heart failure: management and prognosis. In Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 59. Updated by: Michael A.[medlineplus.gov]
  • […] preload and afterload with vasodilating drugs has become a widely accepted adjunctive therapy. 2 3 4 Despite the vigorous application of all these approaches, many patients with congestive heart failure remain symptomatically compromised, and their prognosis[dx.doi.org]
  • […] trials were consistent with these findings, showing that digoxin improves symptoms and prevents clinical deterioration. 11 In atrial fibrillation, however, no such experimental trials exist, and confusion about whether digoxin is truly linked to adverse prognosis[doi.org]

Epidemiology

  • Epidemiologic studies have also demonstrated improved cancer survival in colorectal, breast, head and neck and hepatocellular carcinoma patients on digoxin therapy at the time of cancer treatment.[ncbi.nlm.nih.gov]
  • Elizabeth Platz (Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health) has kindly permitted us to cite her unpublished data: In a longitudinal study of 47,759 health professionals, a significantly decreased relative risk for[doi.org]
  • Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F ; Chronic Kidney Disease Epidemiology Collaboration.[doi.org]
  • […] table for location information Univ. of Michigan Medical Center Ann Arbor, Michigan, United States, 48109-0008 National Center for Research Resources (NCRR) Keywords provided by National Center for Research Resources (NCRR): Digoxin Effect modifiers (Epidemiology[clinicaltrials.gov]
Sex distribution
Age distribution

Pathophysiology

  • Mechanistic understanding of altered renal secretion in renal impairment is one area that may benefit from such models, despite knowledge gaps in renal pathophysiology.[ncbi.nlm.nih.gov]
  • The role of digoxin in the treatment of each of these disease states has changed in recent years as a better understanding of the pathophysiology of these conditions has been gained and new drug therapies have been developed. 1, 2 For the treatment of[accesspharmacy.mhmedical.com]
  • Pathophysiology – Digoxin Toxicity Digoxin blocks the sodium/potassium ATPase pump. The mechanism by which this decreases AV conduction is not clear but is perhaps due to increased vagal tone.[healio.com]
  • Useful For Suggests clinical disorders or settings where the test may be helpful Monitoring digoxin therapy Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test Compounds in the[mayomedicallaboratories.com]

Prevention

  • (via saponin ) anti-arrhythmia drug A drug used for the treatment or prevention of cardiac arrhythmias.[ebi.ac.uk]
  • CONCLUSION: This case reiterates that digoxin toxicity can occur in patients with normal digoxin and potassium levels, and in such patients, magnesium needs to be checked and treated to prevent potentially life-threatening dysrhythmias.[ncbi.nlm.nih.gov]
  • Abstract Drug delivery systems could be applied to locally treat cervical cancer, thus preventing the drawbacks of conventional therapy.[ncbi.nlm.nih.gov]
  • When clinicians know the potential drug-drug interactions that may lead to digoxin toxicity, the mechanisms of interaction, the signs and symptoms of digoxin toxicity, and appropriate monitoring, digoxin toxicity is largely preventable.[ncbi.nlm.nih.gov]
  • The number needed to treat to prevent 1 death was 11 patients. There were no differences in complications between the 2 groups during the interstage period.[ncbi.nlm.nih.gov]

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