Massive digoxin intoxication. Report of a case with serum digoxin level correlation

Area of Science:

• Cardiology
• Clinical Pharmacology
• Toxicology

Background:

• Digoxin is a cardiac glycoside used to treat heart failure and arrhythmias.
• Acute digoxin toxicity can result from intentional overdose, posing significant clinical challenges.
• Understanding the spectrum of cardiac complications is crucial for timely intervention.

Observation:

• A patient intentionally ingested 15 mg of digoxin, leading to a plasma concentration of 38.7 ng/ml.
• The patient exhibited multiple severe cardiac arrhythmias: atrial fibrillation, atrial flutter, sino-atrial block, 3rd-degree atrioventricular block, and ventricular extrasystoles.
• Treatment involved Aprindine, resulting in complete recovery without lasting sequelae.

Findings:

• Massive digoxin overdose can precipitate a wide range of life-threatening cardiac arrhythmias.
• Radioimmunoassay is effective for quantifying digoxin levels in cases of toxicity.
• Prompt and appropriate medical management can lead to favorable outcomes even in severe intoxication.

Implications:

• This case underscores the critical need for vigilant cardiac monitoring in patients with acute digoxin overdose.
• The successful treatment highlights Aprindine as a potential therapeutic option in managing severe digoxin-induced arrhythmias.
• Further research into optimal management strategies for massive digoxin intoxication is warranted to improve patient survival and reduce morbidity.