Related Experiment Videos
Acute pediatric digoxin ingestion
M A Gittelman1, M Stephan, H Perry
1Department of Pediatric Emergency Medicine, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
Insights
Most pediatric digoxin ingestions are mild, but some children develop toxicity. Prompt recognition and treatment, including supportive care or digoxin-specific antibody fragments, are crucial for managing acute cardiac glycoside poisoning in children.
Area of Science:
- Pediatric Toxicology
- Cardiology
- Emergency Medicine
Background:
- Acute ingestions of cardiac glycosides, such as digoxin, are common in children.
- While often asymptomatic, significant toxicity can occur, necessitating prompt medical intervention.
Observation:
- Gastrointestinal upset and first-degree atrioventricular block are the most frequent initial symptoms in symptomatic pediatric patients.
- A history of ingestion may not always be readily available, requiring a high index of clinical suspicion.
Findings:
- Most pediatric patients with acute digoxin ingestion can be managed with activated charcoal and observation.
- A subset of patients will exhibit toxicity, requiring intensive monitoring, medical management, and potentially digoxin-specific antibody fragments.
Implications:
- Clinicians must maintain a high index of suspicion for acute digoxin poisoning in children, even without a clear ingestion history.
- Appropriate diagnostic tests, including digoxin levels, potassium levels, and electrocardiograms (ECGs), are essential for confirming toxicity.
- Timely recognition of clinical manifestations and initiation of appropriate therapy, ranging from supportive care to digoxin-specific antibody fragments, are critical for favorable outcomes.
Abstract:
Although most acute pediatric ingestions of digoxin or other related cardiac glycosides result in minimal or no symptoms, occasionally a child is symptomatic. Gastrointestinal complaints or first-degree AV block are the most common presenting symptoms. Children can generally be given a single dose of activated charcoal, observed, and discharged without any subsequent problems. However, some patients will be toxic and require monitoring, medication, and possibly digoxin-specific antibody fragments. The most important role of the clinician is to recognize the clinical manifestations and institute the appropriate therapy. As in the case presented, the history of an ingestion may not always be obtained initially. Thus, the physician should maintain a high index of suspicion for acute digoxin ingestion and order the appropriate confirmatory tests (eg, a digoxin level, a potassium level, and a 12-lead ECG) when necessary.