The use of central nervous system manifestations in the early detection of digitalis toxicity

Cardiac glycosides have been used therapeutically for more than 3000 years. They have been the treatment of choice for congestive heart failure for many decades, and recently their clinical utility has been redefined. Despite increased telemetry and development of a sensitive radioimmune assay of serum digoxin levels and the availability of digoxin immune Fab fragments (Digibind) to treat digitalis-induced life-threatening dysrhythmias, toxicity remains a serious and common problem. A body of literature, old and new, speaks to the clear but potentially unrecognized role that digitalis-induced central nervous system symptoms can play in the early detection and management of digitalis toxicity.