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Gitaloxin poisoning in a child
S Hachimi-Idrissi1, L Corne, V Maes
1Toxicology Department, University Hospital, Free University Brussels, Belgium.
Intensive Care Medicine
|December 1, 1996
Summary
A child survived a massive gitaloxin overdose, a potent digitalis glycoside. This case highlights the need for intensive monitoring in pediatric gitaloxin poisoning, even with misleading initial symptoms.
Area of Science:
- Cardiology
- Pediatric Toxicology
- Pharmacology
Background:
- Gitaloxin, a digitalis glycoside, shares therapeutic indications with digoxin and digitoxin.
- Digitalis glycosides are commonly used for heart conditions but can be toxic in overdose.
Observation:
- A 2.5-year-old boy ingested 3 mg of gitaloxin, a dose 100 times the normal therapeutic level.
- Initial symptoms included irregular heart rhythm and persistent vomiting.
- Delayed onset of somnolence and bradyarrhythmia (second-degree atrioventricular block) occurred 48 hours post-ingestion.
Findings:
- Symptoms resolved gradually over 96-120 hours, with the atrioventricular block persisting the longest.
- A fluorescence polarization immunoassay for digitoxin showed cross-reactivity with gitaloxin, offering a rough estimate of poisoning severity.
- Successful management was achieved with careful observation in a pediatric intensive care unit.
Implications:
- The clinical presentation of gitaloxin poisoning can be deceptive, necessitating vigilant monitoring in pediatric intensive care settings.
- Immunoassays for digitoxin may serve as a surrogate marker for gitaloxin toxicity in the absence of specific assays.
- This case underscores the importance of prompt and intensive supportive care in managing significant digitalis glycoside poisoning in children.