Digitalis intoxication

Smith, T.W. Butler, W.P. Haber, E. Fozzard, H. Marcus, F.I. Bremner, W.F. Schulman, I.C. and Phillips, A. Treatment of life-threatening digitalis intoxication with digoxin-specific Fab antibody fragments. N Fnal J Med 307(22) 1357-1362, 1982. 

Digoxin Furosemide Hypokalemia may increase risk for digitalis-intoxication... 

Finally, the ICH E14 guideline does not address the possible consequences of QT/ QTc shortening, which may be associated with significant arrhythmias [5,167]. Digitalis intoxication is a known example of drug-induced short QT syndrome associated with polymorphic ventricular tachycardia [ 168]. It should be acknowledged that this is an area of active research and no guidelines can be put forward at the moment. 

Garberoglio, L., Giustetto, C., Wolpert, C. and Gaita, F. (2007) Is acquired short QT due to digitalis intoxication responsible for malignant ventricular arrhythmias Journal of Electrocardiology, 40, 43—46. 

Oral Treatment of hypokalemia in the following conditions With or without metabolic alkalosis digitalis intoxication familial periodic paralysis diabetic acidosis diarrhea and vomiting surgical conditions accompanied by nitrogen loss, vomiting, suction drainage, diarrhea, and increased urinary excretion of potassium certain cases of uremia hyperadrenalism starvation and debilitation corticosteroid or diuretic therapy. 

Hypersensitivity or idiosyncrasy to quinidine or other cinchona derivatives manifested by thrombocytopenia, skin eruption or febrile reactions myasthenia gravis history of thrombocytopenic purpura associated with quinidine administration digitalis intoxication manifested by arrhythmias or AV conduction disorders complete heart block left bundle branch block or other severe intraventricular conduction defects exhibiting marked QRS widening or bizarre complexes complete AV block with an AV nodal or idioventricular pacemaker aberrant ectopic impulses and abnormal rhythms due to escape mechanisms history of drug-induced torsade de pointes history of long QT syndrome. 

Digitalis intoxication Exercise caution in the use of procainamide in arrhythmias associated with digitalis intoxication. Procainamide can suppress digitalis-induced arrhythmias however, if there is concomitant marked disturbance of AV conduction, additional depression of conduction and ventricular asystole or fibrillation may result. Consider use of procainamide only if discontinuation of digitalis, and therapy with potassium, lidocaine, or phenytoin are ineffective. 

Lidocaine is useful in the control of ventricular arrhythmias, particularly in patients with acute myocardial infarction. Lidocaine is the drug of choice for treatment of the electrical manifestations of digitalis intoxication. 

Phenytoin finds its most effective use in the treatment of supraventricular and ventricular arrhythmias associated with digitalis intoxication. The ability of phenytoin to improve digitaUs-induced depression of A-V conduction is a special feature that contrasts with the actions of other antiarrhythmic agents. 

Digitalis glycosides enhance the inotropic state by increasing the intracellular calcium concentration. Intracellular calcium overload is also the mechanism for proarrhythmia associated with digitalis intoxication. The direct effect of digitalis on the electrophysiology of the myocytes is to increase the slope of phase 4 depolarization, an effect that enhances automaticity. 

It is indicated in prophylaxis or treatment of ventricular arrhythmias associated with Ml, digitalis intoxication, ventricular tachyarrhythmia, in patients predisposed to ventricular arrhythmias during general anaesthesia. 

Beller GA, Smith Tw, Abelmann WH, Haber E, Hood WB Jr. Digitalis intoxication a prospective clinical study with serum level correlations. N Engl J Med 1971 284 989-997. 

The antidigitoxin or the antidigoxin antibodies (Digibind) have been used to control digitalis intoxication. The antibody mobilizes depot digoxin and is excreted by the kidney as an anti-body-digoxin complex. 

Kardels B, Beine KH. Acute delirium as a result of digitalis intoxication. Notf Med 2001 27 542-5. 

Wamboldt FS, Jefferson JW, Wamboldt MZ. Digitalis intoxication misdiagnosed as depression by primary care physicians. Am J Psychiatry 1986 143(2) 219-21. 

Song YH, Terao T, Shiraishi Y, Nakamura J. Digitalis intoxication misdiagnosed as depression—revisited. Psychosomatics 2001 42(4) 369-70. 

The prevalence of digitalis intoxication is from 16% to 20%. Color vision disturbances are especially common and may occur before, simultaneously with, or after the onset of cardiac toxicity. Although color vision disturbances are associated with cardiac glycoside toxicity decreased visual acuity without the accompanying classic symptom of xanthopsia is also common. 

Antman E, Wenger TL, Butler VP Jr, Haber E, Smith TW. Treatment of 150 cases of life-threatening digitalis intoxication with digoxin-specific Fab antibody fragments Final report of a multicenter study. Circulation 1990 81 1744-52. 

Atrioventricular block was common (42%) first-degree, 14% second-degree, 17% and complete, 11%). However, first-degree heart block (that is prolongation of the PR interval) without higher degrees of atrioventricular nodal block can occur in the absence of digitalis intoxication. 

Several factors increase patient susceptibihty to digitalis intoxication. They can be considered in two groups (144). 

Hypoxia and acidosis increase the risk of digitalis intoxication. 

Hyperkalemia carries a poor prognosis and is usually an indication for antidigoxin antibody. The suggestion that intravenous calcium should be used to treat the hjrper-kalemia that can occur in digitalis intoxication (173) has been challenged, on the grounds that it can increase the risk of cardiac dysrhythmias in such cases (174). 

Chung EK. Digitalis Intoxication. Amsterdam Excerpta Medica, 1969. 

Buchanan JF, Olson KR. Current management of digitalis toxicity. Part II Treatment of digitalis intoxication. Pract Cardiol 1988 14 92-5. 

Agarwal BL, Agrawal BV, Agarwal RK, Kansal SC. Atrial flutter. A rare manifestation of digitalis intoxication. Br Heart J 1972 34(4) 392-5. 

Singh RB, Agrawal BV, Somani PN. Left bundle branch block a rare manifestation of digitalis intoxication. Acta Cardiol 1976 31(2) 175-9. 

Von Capeller D, Copeland GD, Stern TN. Digitalis intoxication a clinical report of 148 cases. Ann Intern Med 1959 50(4) 869-78. 

Lely AH, van Enter CH. Non-cardiac symptoms of digitalis intoxication. Am Heart J 1972 83(2) 149-52. 

Greenlee JE, Crampton RS, Miller JQ. Transient global amnesia associated with cardiac arrhythmia and digitalis intoxication. Stroke 1975 6(5) 513-16. 

Bernat JL, Sullivan JK. Trigeminal neuralgia from digitalis intoxication. JAMA 1979 241(2) 164. 

Eberhard SM, Woolley S, Zellweger U. Adynamie und Apathie bei Digitalisintoxikation. [Powerlessness and apathy in digitalis intoxication.] Schweiz Rundsch Med Prax 1999 88(17) 772-4. 

Erdmann E, Mair W, Knedel M, Schaumann W. Digitalis intoxication and treatment with digoxin antibody frag- 203. ments in renal failure. KUn Wochenschr 1989 67(1) 16-19. 

Krynicki R, Szumski B, Perkowska J, Dyduszynski A. 210. Digitalis intoxication complicated by recurrent ventricular fibrillation and successfully treated with bretylium tosy-... 

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