Abstract
A case of severe digoxin poisoning is reported. A 46-year-old male suffering from nausea, vomiting and fright after ingesting fifty pills of the cardiac medicine, Methyldigoxin, by mistake, was transferred to our emergency unit. The patient had a serum digoxin level of 46.5ng·ml-1 with hyperkalemia (potassium level of 7.8mEq·l-1) upon admission to the Intensive Care Unit (ICU). The electrocardiogram (ECG) showed fatal arrythmia including complete atrio-ventricular block, bradycardia and ventricular tachycardia. The trachea was intubated under sedation and analgesics and controlled mechanical ventilation was performed because of his agitation and hypoxemia. A temporary pacing wire was placed in the right ventricle. Direct hemoperfusion (DHP) was attempted at the same time to help eliminate the massive dose of digoxin. Hyperkalemia was treated with glucose-insulin, ion-exchange and hemodialysis (HD). The serum digoxin level fell abruptly to 16.6ng·ml-1 within six hours of admission to the ICU. It took three days to reach a therapeutic level of serum digoxin, four days to return to a normal sinus rhythm in the ECG and ten days to leave the ICU. DHP is generally not an effective treatment for digitalis intoxication resulting from long term digoxin administration, but it may be effective in the treatment of acute severe digoxin poisoning after oral intake in the early phase.
