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Digitalis toxicity


Definition:

Digitalis is a medicine that is used to treat certain heart conditions. Digitalis toxicity is a complication of digitalis therapy. It may occur when someone takes too much of the drug at one time. (This is called an acute ingestion, or overdose.) It can also occur when levels of the drug build up for other reasons.

The most common prescription form of this medicine is called digoxin. Digitoxin is another form of digitalis.

Symptoms:

These are symptoms of digitalis toxicity:

Other symptoms may include:

Exams and Tests:

Your health care provider will examine you.

Your heart rate may be rapid, or slow and irregular.

An ECG is done to check for irregular heartbeats.

Blood tests that will be done include:

  • Blood chemistry
  • Kidney function tests, including BUN and creatinine
  • Digitoxin and digoxin test to check levels
  • Potassium level
  • Magnesium level
Treatment:

If the person has stopped breathing, call 911 or your local emergency number, then start CPR.

If the person is having trouble breathing, call 911 or your local emergency number.

At the hospital, symptoms will be treated as appropriate.

Digitoxin blood level may be lowered with repeated doses of charcoal, given after gastric lavage.

Methods to cause vomiting are usually not done because vomiting can worsen slow heart rhythms.

In severe cases, medicines called digoxin-specific antibodies may be prescribed. Dialysis may be needed to reduce the level of digitalis in the body.

Outlook (Prognosis):

How well a person does depends on the severity of the toxicity and if it has caused an irregular heart rhythm.

Possible Complications:
When to Contact a Medical Professional:

Call your provider if you are taking a digitalis medicine and you have symptoms of toxicity.

Prevention:

If you take digitalis medicine, you should have your blood level checked regularly. Blood tests should also be done to check for conditions that make this toxicity more common.

Potassium supplements may be prescribed if you take diuretics and digitalis together. A potassium-sparing diuretic may also be prescribed.

References:

Bain BJ, Nelson LS, Ford MD. Acute poisoning. In: Goldman L, Schafer AI, eds. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 110.

Cole JB, Roberts DJ. Cardiovascular drugs. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 152.

Goldberger AL, Goldberger ZD, Shvilkin A. Digitalis toxicity. In: Goldberger AL, ed. Clinical Electrocardiography: A Simplified Approach, 8th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 18.

Zeringue M, Fowler GC. Gastrointestinal decontamination. In: Pfenninger JL, Fowler GC, eds. Pfenninger and Fowler's Procedures for Primary Care. 3rd ed. Philadelphia, PA: Elsevier Mosby; 2011:chap 202.


Review Date: 4/20/2015
Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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