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[Thrombocytopenia in digitoxin poisoning]
A W Schneider1, H J Gilfrich, L Fechler
1I. Medizinische Klinik, St.-Katharinen-Krankenhauses, Frankfurt, Main.
Deutsche Medizinische Wochenschrift (1946)
|February 28, 1992
Summary
An 80-year-old woman experienced digitoxin toxicity, including bradyarrhythmia and thrombocytopenia, after self-increasing her medication dose. Cholestyramine successfully lowered digitoxin levels and improved platelet count, demonstrating its efficacy in managing digitoxin toxicity.
Area of Science:
- Cardiology
- Clinical Pharmacology
- Toxicology
Background:
- Digitoxin is a cardiac glycoside used to treat heart failure and arrhythmias.
- Maintaining therapeutic digitoxin levels is crucial to avoid toxicity.
- Self-adjustment of medication dosage can lead to adverse events.
Observation:
- An 80-year-old woman self-administered supratherapeutic doses of digitoxin.
- She presented with symptoms of digitoxin toxicity, including faintness, visual disturbances, and severe bradyarrhythmia (heart rate ~40/min).
- Laboratory findings revealed markedly elevated digitoxin levels (70.8 ng/ml) and significant thrombocytopenia (33,000/microliters).
Findings:
- The patient's electrocardiogram (ECG) showed second-degree atrioventricular (AV) block.
- Cholestyramine was administered to interrupt the enterohepatic circulation of digitoxin, avoiding the need for digitalis-binding antibody fragments.
- Following cholestyramine treatment, the patient's platelet count normalized (147,000/microliters) as digitoxin levels decreased, although levels remained above the therapeutic range.
Implications:
- This case highlights the potential for severe toxicity, including thrombocytopenia, from self-administered digitoxin overdose.
- Cholestyramine can be an effective treatment for digitoxin toxicity by reducing drug reabsorption.
- Close monitoring of drug levels and platelet counts is essential in patients with suspected digitoxin toxicity.