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[A baby with digoxin toxicity]

Louise M Andrews1, Patrycja J Puiman, Heleen van der Sijs

  • 1Erasmus Medisch Centrum, Rotterdam.

Nederlands Tijdschrift Voor Geneeskunde
|May 7, 2015
PubMed

Insights

A 5-month-old boy experienced digoxin toxicity from a tenfold overdose. Prompt administration of digoxin antibodies successfully reversed the toxic effects, normalizing levels within days.

Area of Science:

  • Pediatric Toxicology
  • Cardiology
  • Clinical Pharmacology

Background:

  • Accidental poisoning in children poses diagnostic challenges due to communication barriers.
  • Digoxin overdose can lead to severe, life-threatening complications in pediatric patients.

Observation:

  • A 5-month-old infant accidentally received a tenfold dose of digoxin for five days.
  • The infant presented with feeding difficulties, vomiting, weight loss, electrolyte imbalances (hyponatremia, hyperkalemia), elevated renal markers, and ECG abnormalities.

Findings:

  • The patient's digoxin plasma concentration was significantly elevated at 7.6 µg/l.
  • Administration of digoxin-specific antibodies rapidly reduced digoxin levels to < 0.3 µg/l.
  • A secondary rise in digoxin concentration to 3.1 µg/l occurred 12 hours post-treatment due to redistribution, before normalizing within the therapeutic range within 2 days.

Implications:

  • Digoxin toxicity in infants requires prompt recognition and management.
  • Digoxin antibodies are a highly effective antidote for severe digoxin poisoning in children.
  • Monitoring drug levels post-treatment is crucial to manage redistribution effects.

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