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Massive digoxin intoxication in childhood

H Stopfkuchen, H J Gilfrich, B K Jüngst

Intensive Care Medicine

|November 1, 1978

Summary

A 10-year-old boy experienced a record high serum digoxin level after ingestion, leading to severe cardiac issues. Early diphenylhydantoin treatment prevented life-threatening arrhythmias in this pediatric digitalis toxicity case.

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Area of Science:

Cardiology
Pediatric Toxicology
Pharmacology

Background:

Digoxin is a cardiac glycoside used to treat heart failure and arrhythmias.
Pediatric digoxin toxicity can lead to severe cardiac complications.
Accurate measurement of serum digoxin levels is crucial for management.

Observation:

A 10-year-old boy ingested approximately 16 mg of beta-acetyl-digoxin.
The maximum measured serum digoxin level was 31.8 ng/ml, the highest reported in childhood.
Significant hyperkalemia (serum potassium 7.4 mmol/l) was observed.

Findings:

The patient developed complete atrio-ventricular block.
Multiple episodes of ventricular premature beats occurred.
Despite the high digoxin level and cardiac disturbances, no life-threatening arrhythmias were documented.

Implications:

This case highlights the extreme toxicity possible with significant digoxin overdose in children.
Early administration of diphenylhydantoin may have mitigated life-threatening rhythm disturbances.
This case underscores the importance of prompt medical intervention in pediatric digitalis poisoning.

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