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Bidirectional tachycardia after an acute intravenous administration of digitalis for a suicidal gesture
Diletta Sabatini1, Giovanni Truscelli2, Antonio Ciccaglioni2
1Emergency Toxicology and Poison Control Center Unit, Policlinico Umberto I and Department of Physiology and Pharmacology "V. Erspamer", School of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy.
Abstract:
Acute digoxin intoxication is a life-threating condition associated with severe cardiotoxicity. Female gender, age, low lean body mass, hypertension, and renal insufficiency may worsen the prognosis. Arrhythmias caused by digitalis glycosides are characterized by an increased automaticity coupled with concomitant conduction delay. Bidirectional tachycardia is pathognomonic of digoxin intoxication, but it is rarely observed. An 83-year-old woman was admitted to the Emergency Department after self-administration of 5 mg of digoxin i.v. for suicidal purpose. Her digoxin serum concentration was 17.4 ng/mL. The patient developed a bidirectional tachycardia and the Poison Control Center of the hospital provided digoxin immune fab. Bidirectional tachycardia quickly reversed and the patient remained stable throughout the hospital stay. This case shows that a multiple disciplinary approach, involving cardiologists and toxicologists, is essential for the management of digoxin intoxication. The optimal treatment of this rare event depends on the clinical conditions and on the serum drug concentration of the patient. Digoxin immune fab represents a safe, effective, and specific method for rapidly reversing digitalis cardiotoxicity and should be started as soon as the diagnosis is defined.
Insights
Acute digoxin intoxication is a life-threatening condition. Digoxin immune fab effectively and rapidly reversed severe cardiotoxicity, including bidirectional tachycardia, in a patient with high digoxin levels.
Area of Science:
- Cardiology
- Toxicology
- Pharmacology
Background:
- Acute digoxin intoxication presents a severe, life-threatening risk due to cardiotoxicity.
- Factors like female gender, advanced age, low lean body mass, hypertension, and renal insufficiency can exacerbate the prognosis.
- Digitalis glycoside-induced arrhythmias involve increased automaticity and conduction delays, with bidirectional tachycardia being a rare but pathognomonic sign.
Purpose of the Study:
- To report a case of severe digoxin intoxication successfully treated with digoxin immune fab.
- To highlight the importance of a multidisciplinary approach in managing digoxin toxicity.
- To emphasize the efficacy and safety of digoxin immune fab in reversing digitalis-induced cardiotoxicity.
Main Methods:
- A case study of an 83-year-old female patient with self-administered digoxin overdose (5 mg IV).
- Management involved intensive care, monitoring of serum digoxin concentration (17.4 ng/mL), and administration of digoxin immune fab.
- The patient's condition was managed through collaboration between cardiologists and toxicologists.
Main Results:
- The patient presented with bidirectional tachycardia, a hallmark of severe digoxin intoxication.
- Administration of digoxin immune fab led to rapid reversal of the bidirectional tachycardia.
- The patient stabilized and remained in stable condition throughout her hospital stay.
Conclusions:
- Digoxin immune fab is a safe, effective, and specific antidote for rapidly reversing digitalis cardiotoxicity.
- A multidisciplinary approach involving cardiologists and toxicologists is crucial for optimal management of digoxin intoxication.
- Treatment decisions should be guided by clinical presentation and serum drug concentrations.