Sage Journals: Discover world-class research

Abstract

Digoxin is a cardiotonic glycoside that is primarily used in the treatment of heart failure, atrial fibrillation or flutter, and paroxysmal atrial tachycardia. Intoxication due to digitalis excess is a common problem in clinical practice because it is therapeutically effective within a narrow dose range. However, massive intoxication with digitalis glycosides following a suicidal attempt is a rare event. In this report we describe an overdose fatality involving digoxin in a suicidal 82-year-old man, in whom measurement of serum digoxin concentration is available. A toxicological study of our patient, approximately two and a half hours after ingestion of the drug, revealed digoxin concentrations within 12.2–13.2 ng/ml in the blood, while the mean therapeutic serum concentration ranged from 0.5 to 2 ng/ml.

Get full access to this article

View all access options for this article.

References

Beller

G. A.

Smith

T. W.

Abelmann

W. H.

Harber

Hood

W.B.

Jr. (1971) Digitalis intoxication: A prospective clinical study with serum level correlations. New Eng. J. Med. 284, 989–97

Bergy

C. G.

Fergus

E. B.

Bruce

R. A.

(1957) Acute massive digitoxin poisoning; report of a case and review of the literature. Ann. Intern. Med. 46, 964–76

Buchanan

(1967) Self poisoning with digitalis glycosides. Brit. Med. J. 3, 661

Chan

Ikram

(1976) A case of self-induced digoxin poisoning: With His bundle studies of the site of heart block. New Zealand Med. J. 8, 443–6

Commerford

P. J.

Lloyd

E. A.

(1984) Arrhythmias in patients with drug toxicity, electrolyte and endocrine disturbances. Med. Clinics N. Am. 68, 1051–78

DiMaio

V.J.M.

Garriot

J. C.

Putnam

(1975) Digoxin concentrations in post-mortem specimens after overdose and therapeutic use. J. Forensic Sci. 20(2), 340–7

Dunn

W. A.

Lockrey

L. A.

McCain

M. W.

Siek

T. J.

(1994) A report of a suicide involving digoxin and doxepin. J. Anal. Toxicol. 18, 122–3

Hobson

J. D.

Zettner

(1973) Digoxin serum half-life following suicidal digoxin poisoning. JAMA 223, 147–9

Hoffman

B. F.

Bigger

J.T.

Jr. (1980) Digitalis and allied cardiac glycosides. In: Goodman

Gilman

(Eds). The Pharmacological Basis of Therapeutics, (6th ed) New York, Macmillan Publishing, 729–60

10.

Klein-Schwartz

Oderda

G. M.

(1991) Poisoning in the elderly. Epidemiological, clinical and management considerations. Drugs Ageing 1, 67–89

11.

Ordog

G. J.

Benaron

Bhasin

Wasserberger

Balasubramanium

(1987) Serum digoxin levels and mortality in 5.100 patients. Ann. Emerg. Med. 16(1), 32–9

12.

Pick

Igarashi

(1969) Mechanism, differential diagnosis, and clinical significance of digitalis-induced arrhythmias. In: Surawicz

Fisch

(Eds). Digitalis. New York, Grune and Stratton, Inc., 148

13.

Ranquin

Parizel

(1975) Massive digoxin intoxication. Report of a case with serum digoxin level correlation. Acta Cardiologica 5, 375–82

14.

Smith

T. W.

Butler

V. P.

Harber

(1969) Determination of therapeutic and toxic serum digoxin concentrations by radioimmunoassay. New England J. Med. 281, 1212–6

15.

Smith

T. W.

Harber

(1971) The clinical value of serum digitalis glycoside concentrations in the evaluation of drug toxicity. Ann. NY Acad. Sci. 179, 322–76

16.

Smith

T. W.

Willerson

J. T.

(1971) Suicidal and accidental digoxin ingestion. Circulation 44, 29–36

17.

Yavagal

S. T.

Rangaraj

(1994) Suicidal digoxin ingestion. J. Assoc. Phys. Ind. 42, 63–4

2. Report of a Suicidal Digoxin Intoxication: A Case Report

Abstract

Get full access to this article

References