Abstract
We report a neonate with severe digoxin intoxication. The patient was a 23-day-old girl. Two days after birth, she was diagnosed with ventricular septal defect (VSD), patent ductus arterious (PDA), and atrial septal defect (ASD). Treatment with furosemide, spironolactone, digoxin, and enalapril maleate was started. After she was discharged from the previous hospital, vomiting was noted. She was referred and admitted to our hospital 23 days after birth. On admission, she demonstrated hypovolemic shock judging from weight loss, an anterior fontanel excavation, oliguria, and marked peripheral coldness. Blood drug concentration measurement and blood chemistry showed increases in the serum digoxin, blood urea nitrogen (BUN), creatinine (Cre), and potassium ion (K+) levels. These findings suggested severe digoxin intoxication with hyperpotassiumemia and acute renal failure. The oral agents were discontinued, and transfusion loading and glucose-insulin (GI) therapy were performed, leading to a favorable outcome. In Japan, no specific antibody against digoxin has become commercially available. Furthermore, digoxin has large volume of distribution; it cannot be removed by hemocatharsis therapy. Therefore, it is important to prevent serious complications by continuing the correction of serum electrolytes and symptomatic therapy for arrhythmia until digoxin is excreted.
