Digitalis toxicity
Key points
- Digitalis toxicity is a complication of digitalis therapy, or it may be caused by an acute ingestion of digitalis.
- Digitalis toxicity is the result of the body accumulating more digitalis than it can tolerate at that time.
- In an emergency, assist breathing as needed (see CPR) and obtain professional medical assistance.
- The outcome varies depending on the extent of toxicity and arrhythmias that develop.
Definition
Digitalis toxicity is a complication of digitalis therapy, or it may be caused by an acute ingestion of digitalis.
Causes, incidence, and risk factors
Digitalis toxicity is the result of the body accumulating more digitalis than it can tolerate at that time. That can be caused by high levels of digitalis in the body, or it can be caused by "normal" levels but decreased tolerance by the body. Digitalis toxicity can occur from a single exposure, chronic overmedication, or can be precipitated with normal blood levels of digitalis if other risks are present.
Risks include taking digitalis medications such as digoxin or digitoxin, along with medications that interact with digitalis such as quinidine, verapamil, amiodarone, and others.
People with heart failure are commonly given diuretics (medications used to pull excess fluid from the body) along with digoxin. Many diuretics can cause potassium loss. Low levels of potassium in the body increases the risk of digitalis toxicity. Digitalis toxicity can also be precipitated by low levels of magnesium in the body.
Reduced kidney function will cause digitalis to accumulate in the body rather than being excreted normally through urine. Therefore, any disorders that disrupt kidney functioning (including dehydration) make digitalis toxicity more likely.
Symptoms
- Visual changes (unusual)
o Halos or rings of light around objects
o Seeing lights or bright spots
o Changes in color perception
o Blind spots in vision
o Blurred vision - Confusion
- Loss of appetite
- Nausea, vomiting, diarrhea
- Palpitations
- Irregular pulse
Additional symptoms that may be associated with digitalis toxicity include the following:
- Decreased urine output
- Excessive nighttime urination
- Overall swelling
- Decreased consciousness
- Difficulty breathing when lying down
Signs and tests
- The heart rate may be rapid or slow and it may be irregular.
- ECG may show any of a variety of arrhythmias.
- Serum levels of digoxin or digitoxin may be high or normal (digoxin - test, digitoxin - test).
Written and revised by
Gerald Hurowitz, M.D.
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