Dangerous Overdose: Myocardial Injury from Digitoxin Intoxication
AI Summary
Severe digitoxin overdose can cause myocardial injury, ECG changes including first degree AV block and ST-segment scooping, with raised troponin.
Prompt clinical risk assessment and therapy are essential; decisions and response evaluation must be guided by the patient's clinical presentation.
Treatment with digitalis antitoxin (DigiFab) can rapidly improve condition under intensive monitoring, although serum digitoxin levels may fall slowly.
MEDICAL HISTORY: An 82-year-old woman was brought to the emergency department by ambulance due to nausea, general weakness, and increasing confusion. Two days earlier, she had ingested 60 tablets of digitoxin (each containing 0.07 mg) in a suicide attempt.
FINDINGS: The ECG showed a normofrequent sinus rhythm, a first-degree AV block, and ST-segment scooping in leads II, aVF, and V2-V6. The digitoxin level was above the detection threshold. Troponin levels were elevated.
DIAGNOSIS: Digitoxin intoxication with myocardial damage following a suicide attempt.
THERAPY AND COURSE: Due to the potentially life-threatening condition, the patient was treated with digitalis antitoxin (DigiFab). Under intensive care monitoring, her clinical condition improved rapidly. The digitoxin levels decreased slowly. She was discharged after 8 days.
CONCLUSION: Digitoxin intoxication can lead to significant myocardial damage. Risk assessment, therapy, and evaluation of therapeutic response should be conducted promptly and always based on the clinical presentation.
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