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Prognostic implications of hyperkalemia in toad toxin intoxication
1Department of Emergency Medicine, Taichung Veterans General Hospital, Taiwan, Republic of China.
Abstract:
The toad possesses several toxic substances. Toad toxin poisoning manifests itself primarily with digitalis-like, cardioactive effects which results in bradycardia, varying degrees of atrio-ventricular block, ventricular tachycardia, ventricular fibrillation and sudden death. We report a cluster poisoning in a family who became intoxicated after ingestion of cooked toad soup for a skin problem. The youngest one (15 months old) died of refractory bradydyarrhythmias soon after arriving at our hospital. A second child (20 months old), who survived, arrived in shock with hyperkalemia (potassium 7.3 mEq/ L) and varying degrees of atrio-ventricular block. She was successfully treated with atropine, lidocaine, and cardioversion, and had a transvenous temporary pacemaker implanted for 1 day. The third boy (16 years old) had hyperkalemia (potassium 6.3 mEq/L) and bradycardia. The remaining three adults had only mild symptoms of nausea, vomiting, watery diarrhea and a sensation of numbness over their oral mucosa. We found that the level of serum potassium had prognostic implications in toad intoxication. Determination of serum potassium level is readily available in almost every hospital and is therefore more convenient to measure than serum digoxin level. We conclude that if hyperkalemia develops, the treatment of toad intoxication must be more aggressive to prevent mortality.
Insights
Toad toxin ingestion can cause severe heart problems and death. Monitoring serum potassium levels is crucial for predicting prognosis and guiding aggressive treatment in toad poisoning cases.
Area of Science:
- Toxicology
- Cardiology
- Dermatology
Background:
- Toad toxins exhibit digitalis-like cardioactive effects, leading to arrhythmias and potential sudden death.
- A family ingested cooked toad soup for a skin condition, resulting in a cluster poisoning incident.
Observation:
- The youngest child (15 months) died from refractory bradyarrhythmias.
- A second child (20 months) presented with shock, hyperkalemia (7.3 mEq/L), and atrioventricular block, requiring intensive treatment including a temporary pacemaker.
- A 16-year-old boy experienced hyperkalemia (6.3 mEq/L) and bradycardia, while three adults had milder gastrointestinal and oral symptoms.
Findings:
- Serum potassium levels demonstrated prognostic significance in toad intoxication.
- Elevated serum potassium levels correlated with more severe cardiac manifestations and poorer outcomes.
- Serum potassium measurement is a readily available and convenient prognostic tool compared to serum digoxin levels.
Implications:
- Aggressive treatment strategies are essential when hyperkalemia is present in toad intoxication to prevent mortality.
- Early recognition of hyperkalemia can guide timely and intensive medical intervention.
- This study highlights the importance of considering toad toxin exposure in cases of unexplained cardiac arrhythmias, especially in regions where toad consumption is prevalent.