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Digitalis toxicity in infants and children

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Summary

There is a narrow difference between the therapeutic and toxic ranges of cardiac glycosides. The availability in the past decade of radioimmunoassays for accurate measurement of these glycosides has resulted in an improved understanding of their pharmacokinetics and clinical use. Despite these advances, however, digitalis toxicity is still a common problem in infants and children.

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References

  1. Andersson KS, Bertler A, Wettrell G (1975) Postmortem distribution and tissue concentrations of digoxin in infants and adults.Acta Paediatr Scand 64:497–504

    PubMed  CAS  Google Scholar 

  2. Asplund J, Edhag O, Mogensen L, Nyquist O, Orinius E, Sjogren A (1971) Four cases of massive digitalis poisoning.Acta Med Scand 189:293–297

    Article  PubMed  CAS  Google Scholar 

  3. Beck OA, Kramer KD, Hochrein H (1974) Verlauf einer suizidalen Digoxin-Intoxikation mit Hyperkaliämie.Dtsch Med Wochenschr 99:756–764

    Article  PubMed  CAS  Google Scholar 

  4. Beller GA, Smith TW, Abelmann WH, Haber E, Hood WB (1971) Digitalis intoxication: prospective clinical study with serum level concentrations.N Engl J Med 284:989–997

    Article  PubMed  CAS  Google Scholar 

  5. Berdeaux A, Batisse A, Richer C, Kachaner J, Giudicelli JF (1977) Le dosage de la digoxine plasmatique chez le nouveau-né. Applications practiques.Nouv Presse Med 6:2142–2144

    PubMed  CAS  Google Scholar 

  6. Berman W Jr, Dubynsky O, Whitman V, Friedman Z, Maisels MJ, Musselman J (1978) Digoxin therapy in low-birth-weight infants with patent ductus arteriosus.Pediatrics 93:652–655

    Google Scholar 

  7. Bismuth C, Gaultier M, Conso F, Efthymiou MI (1973) Hyperkalemia in acute digitalis poisoning: prognostic significance and therapeutic implications.Clin Toxicol 6:153–162

    Article  PubMed  CAS  Google Scholar 

  8. Bremmer WF, Third JLHC, Lawrie TDV (1977) Massive digoxin ingestion: report of a case and review of currently available therapies.Br Heart J 39:688–692

    Google Scholar 

  9. Burchell HB (1983) Digitalis poisoning: historical and forensic aspects.J Am Coll Cardiol 1:506–516

    Article  PubMed  CAS  Google Scholar 

  10. Doering W (1979) Quinidine-digoxin interaction: pharmacokinetic underlying mechanism and clinical implications.N Engl J Med 30:400–404

    Article  Google Scholar 

  11. Doherty JE, Perkins WH, Wilson MC (1964) Studies with tritiated digoxin in renal failure.Am J Med 37:536–544

    Article  PubMed  CAS  Google Scholar 

  12. Doherty JE, Perkins WH (1966) Digoxin metabolism in hypo- and hyperthyroidism.Ann Intern Med 64:489–507

    PubMed  CAS  Google Scholar 

  13. Duhme DW, Greenblatt DS, Koch-Weser J (1974) Reduction of digoxin toxicity associated with measurement of serum levels.Ann Intern Med 80:516–519

    PubMed  CAS  Google Scholar 

  14. Erbel R, Kraemer R, Kleesick K, Schweizer P, Pop T, Effert S (1979) Suizidale Digitalisintoxikation — Beziehung zwischen der Digitalis-Serum Konzentration und den elektrokardiographischen Befunden.Z Kardiol 68:590–598

    PubMed  CAS  Google Scholar 

  15. Ezrin AM, Bassett AL, Gelband H (1983) Cellular electrophysiology in the developing mammalian heart. In: Roberts NK, Gelband H (eds)Cardiac arrhythmias in the neonate, infant and child, 2nd edn. Appleton-Century-Crofts, Norwalk, CT, pp 37–58

    Google Scholar 

  16. Fisch C (1971) Digitalis intoxication.JAMA 216:1770–1773

    Article  PubMed  CAS  Google Scholar 

  17. Fowler RS, Rathi L, Keith JD (1964) Accidental digitalis intoxication in children.J Pediatr 64:188–200

    Article  PubMed  CAS  Google Scholar 

  18. Freeman R, Farrar JF, Robertson EJ (1961) Accidental digitalis poisoning in childhood.Med J Aust 48:655–659

    PubMed  Google Scholar 

  19. Gellis SS, Kagan BM (1982)Current pediatric therapy. WB Saunders, Philadelphia, pp 136–137 and 654–675

    Google Scholar 

  20. Gilfrich HJ, Engel HJ, Prellwitz W (1981) Magnesium concentrations in saliva: an indicator of digitalis toxicity.Klin Wochenschr 59:617–621

    PubMed  CAS  Google Scholar 

  21. Gorelick DA, Kussin SZ, Kahn I (1978) Paranoid delusions and auditory hallucinations associated with digoxin intoxication.J Nerv Ment Dis 166:817–819

    Article  PubMed  CAS  Google Scholar 

  22. Gosselin RE, Hodge HC, Smith RP, Gleason MN (eds) (1975)Clinical toxicology of commercial products, 4th edn. Williams and Wilkins, Baltimore, sec III, pp 124–133

    Google Scholar 

  23. Greenwood H, Howard M, Landon J, Fraser B, Shinebourne E (1977) Development of a highly sensitive radioimmunoassay for digoxin and its application in pediatric practice.Eur J Cardiol 515:413–424

    Google Scholar 

  24. Halkin H, Randomsky M, Blieden L, Frand M, Millman P, Boichis H (1978) Steady state serum digoxin concentration in relation to digitalis toxicity in neonates and infants.Pediatrics 61:184–188

    PubMed  CAS  Google Scholar 

  25. Harris MM, Hariprasad MK, Khalid S (1981) Asymptomatic digoxin toxicity [letter].N Engl J Med 305:643

    PubMed  CAS  Google Scholar 

  26. Hastreiter AR, Simonton RL, Van der Horst R, Benawra R, Mangurten J, Lam G, Chiou WL (1982) Digoxin pharmacokinetics in premature infants.Pediatr Pharmacol 2:23–31

    CAS  Google Scholar 

  27. Hastreiter AR, Kim PW, Van der Horst R (1983) Accidental digoxin overdose in an infant: postmortem tissue concentrations.J Forens Sci 28:482–488

    CAS  Google Scholar 

  28. Hastreiter AR, Van der Horst R (1984) Tissue concentrations at autopsy of infants and children receiving therapeutic digoxin.J Forens Sci (in press)

  29. Hauck AJ, Ongley PA, Nadas AS (1958) The use of digoxin in infants and children.Am Heart J 56:443–457

    Article  PubMed  CAS  Google Scholar 

  30. Hayes CJ, Butler VP, Gersony WM (1973) Serum digoxin studies in infants and children.Pediatrics 52:561–568

    PubMed  CAS  Google Scholar 

  31. Holt DW, Benstead JG (1975) Postmortem assay of digoxin by radioimmunoassay.J Clin Pathol 28:483–486

    PubMed  CAS  Google Scholar 

  32. Hobson JD, Zettner A (1973) Digoxin serum half-life following suicidal digoxin poisoning.JAMA 223:147–149

    Article  PubMed  CAS  Google Scholar 

  33. Johnson GL, Desai NS, Pauly TH, Cunningham MD (1982) Complications associated with digoxin therapy in low-birth-weight infants.Pediatrics 69:463–465

    PubMed  CAS  Google Scholar 

  34. Joos HA, Johnson JL (1957) Digitalis intoxication in infancy and childhood.Pediatrics 20:866–876

    PubMed  CAS  Google Scholar 

  35. Kim PW, Krasula RW, Soyka LF, Hastreiter AR (1975) Postmortem digoxin tissue concentrations in infants and children.Circulation 52:1128–1131

    PubMed  CAS  Google Scholar 

  36. Krasula R, Yanagi R, Hastreiter AR, Levitsky S, Soyka LF (1974) Digoxin intoxication in infants and children: correlation with serum levels.J Pediatr 84:265–269

    Article  PubMed  CAS  Google Scholar 

  37. Levine OR, Blumenthal S (1962) Digoxin dosage in premature infants.Pediatrics 29:8–25

    Google Scholar 

  38. Levin OR, Somlyo AP (1962) Digitalis intoxication in premature infants.J Pediatr 61:70–78

    Google Scholar 

  39. Levy A, Leaman DM, Hanson JS (1972) Effects of digoxin on systolic time intervals of neonates and infants.Circulation 46:816–823

    PubMed  CAS  Google Scholar 

  40. Loes MW, Singh S, Lock JE, Mirkin BL (1978) Relation between plasma and red cell electrolyte concentrations and digoxin levels in children.N Engl J Med 299:501–504

    Article  PubMed  CAS  Google Scholar 

  41. McNamara DG, Brower EJ, Perry GD (1964) Accidental poisoning of children with digitalis.N Engl J Med 271:1106–1108

    Article  PubMed  CAS  Google Scholar 

  42. Morrison J, Killip T (1971) Hypoxemia and digitalis toxicity in patients with chronic lung disease.Circulation 44:11–41

    Google Scholar 

  43. Morselli PL, Franco-Morselli R, Bossi L (1980) Clinical pharmacokinetics in newborns and infants: age-related differences and therapeutic implications.Clin Pharmacokinet 5:485–527

    Article  PubMed  CAS  Google Scholar 

  44. Murphy DJ, Bremner WF, Haber E, Butler VP, Smith TW, Gaum WE (1982) Massive digoxin poisoning treated with Fab fragments of digoxin-specific antibodies.Pediatrics 70:472–473

    PubMed  Google Scholar 

  45. Nadas AS, Rudolph AM, Reinhold JD (1953) The use of digitalis in infants and children.N Engl J Med 248:98–105

    Article  PubMed  CAS  Google Scholar 

  46. Neutze JM, Rutherford JD, Hurley PJ (1977) Serum digoxin levels in neonates, infants, and children with heart disease.N Zeal Med J 86:7–10

    CAS  Google Scholar 

  47. Osterloh J, Herold S, Pond S (1982) Oleander interference in the digoxin radioimmunoassay in a fatal ingestion.JAMA 247:1596–1597

    Article  PubMed  CAS  Google Scholar 

  48. Pick A (1967) Digitalis and the electrocardiogram.Circulation 15:603–608

    Google Scholar 

  49. Pickoff AS, Singh S, Gelband H (1983) The medical management of cardiac arrhythmias. In: Roberts NK, Gelband H (eds)Cardiac arrhythmias in the neonate, infant and child, 2nd edn. Appleton-Century-Crofts, Norwalk, CT, pp 297–339

    Google Scholar 

  50. Pinsky WW, Jacobsen JR, Gillette PC, Adams J, Monroe L, McNamara DG (1979) Dosage of digoxin in premature infants.J Pediatr 94:639–642

    Article  PubMed  CAS  Google Scholar 

  51. Reza MS, Kovich RB, Shine KL, Pearce ML (1979) Massive intravenous digoxin overdose.N Engl J Med 291:777–778

    Article  Google Scholar 

  52. Rietbrock N, Alken RG (1980) Color vision difficiencies: a common sign of intoxication in chronically digoxin-treated patients.J Cardiovasc Pharmacol 2:93–99

    PubMed  CAS  Google Scholar 

  53. Rosen MR (1981) Cellular mechanisms of cardiac arrhythmias. In: Harrison DC (ed)Cardiac arrhythmias: a decade of progress. GK Hall, Boston, pp 25–38

    Google Scholar 

  54. Rosenbaum JL (ed) (1980) Clinical aspects of hemoperfusion for intoxication.Clin Toxicol 17:491–527

    Google Scholar 

  55. Rumack BH, Wolfe RR, Pilfrich H (1974) Phenytoin (diphenylhydantoin) treatment of massive digoxin overdose.Br Heart J 36:405–408

    PubMed  CAS  Google Scholar 

  56. Rumack BH (ed) (1974–83)Pois index Englewood Co Michael Medex Inc 1983

  57. Sandor GGS, Bloom KR, Izukawa T, Patterson KWH, Rowe RD (1980) Noninvasive assessment of left ventricular function related to serum levels in neonates.Pediatrics 65:541–546

    PubMed  CAS  Google Scholar 

  58. Semple P, Tilstone WJ, Lawson DH (1975) Furosemide and urinary digoxin clearance.N Engl J Med 293:612

    Article  Google Scholar 

  59. Shapiro W (1978) Correlation studies of serum digitalis level and the arrhythmias of digitalis intoxication.Am J Cardiol 46: 852–859

    Article  Google Scholar 

  60. Sherman JL, Locke RV (1960) Transplacental neonatal digitalis intoxication.Am J Cardiol 6:834–837

    Article  Google Scholar 

  61. Smith TW, Willerson JT (1971) Suicidal and accidental digoxin ingestion. Report of five cases with serum digoxin level correlations.Circulation 44:29–36

    PubMed  CAS  Google Scholar 

  62. Smith TW, Butler VP Jr, Haber E, Fozzard H, Marcus FL, Bremner WF, Schulman IC, Phillips A (1982) Treatment of life-threatening digitalis intoxication with digoxin-specific Fab antibody fragments: experience in 26 cases.N Engl J Med 307:1357–1362

    Article  PubMed  CAS  Google Scholar 

  63. Soffer A (1961) The changing clinical picture of digitalis intoxication.Arch Intern Med 107:113–120

    Google Scholar 

  64. Somberg JC, Smith TW (1979) Localization of the neurally mediated arrhythmogenic properties of digitalis.Science 204:321–323

    PubMed  CAS  Google Scholar 

  65. Spiehler VR, Sedgwick BS, Richards RG (1981) The use of brain digoxin concentrations to confirm blood digoxin concentrations.J Forens Sci 26:645–650

    CAS  Google Scholar 

  66. Steiness EVA (1974) Renal tubular secretion of digoxin.Circulation 50:103–107

    PubMed  CAS  Google Scholar 

  67. Stopfkuchen H, Gilfrich HJ, Jungst BK, Gempp W (1978) Massive digoxin intoxication in childhood.Intensive Care Med 4:199–201

    Article  PubMed  CAS  Google Scholar 

  68. Swanson M, Cacace L, Chun G, Itano M (1973) Saliva calcium and potassium concentrations in the detection of digitalis toxicity.Circulation 47:736–743

    PubMed  CAS  Google Scholar 

  69. Vorpahl TE, Loe JL (1977) Correlation of antemortem and postmortem digoxin levels.J Forens Sci 23:329–334

    Google Scholar 

  70. Wagner JG (1976) Linear pharmacokinetic equations allowing direct calculation of many needed pharmacokinetic parameters from the coefficients and exponents of polyexponential equations which have been fitted to the data.J Pharmacokinet Biopharm 4:443–467

    Article  PubMed  CAS  Google Scholar 

  71. Wettrell G, Andersson KE (1977) Clinical pharmacokinetics of digoxin in infants.Clin Pharmacokinet 2:17–31

    PubMed  CAS  Google Scholar 

  72. Wettrell G, Andersson KE, Nyberg L (1976) Effect of exchange transfusion on the elimination of digoxin in neonates.Eur J Clin Pharmacol 10:25–29

    Article  Google Scholar 

  73. Windorfer A Jr, Pringsheim W, Gadecke R, Schumacher G (1974) Digoxin-Serumkonzentrationen und Digitalis Überdosierung bei Neugeborenen, Säuglingen und Kleinkindern.Z Kinderheilk 118:207–217

    Article  PubMed  CAS  Google Scholar 

  74. Withering W (1785) An account of the foxglove and some of its medical uses. Reprinted inMed Classics 2:295, 1937

    Google Scholar 

  75. Zucker AR, Lacina SJ, Das Gupta DS, Fozzard HA, Mchlman L, Butler VP Jr, Haber E, Smith TW (1982) Fab fragments of digoxin specific antibodies used to reverse ventricular fibrillation induced by digoxin ingestion in a child.Pediatrics 70:468–470

    PubMed  CAS  Google Scholar 

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Supported in part by the University of Illinois Foundation Goodenberger Medical Research Grant 2-6-46856.

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Hastreiter, A.R., van der Horst, R.L. & Chow-Tung, E. Digitalis toxicity in infants and children. Pediatr Cardiol 5, 131–148 (1984). https://doi.org/10.1007/BF02424966

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