Chronic Digoxin Toxicity Leading to Institutionalization of an Elderly Woman

Nix, Kimberley; Radu, Luiza; Zou, Jason; Vlasschaert, Meghan

doi:10.4212/cjhp.v75i2.3069

Cited by 2 publications

(1 citation statement)

References 15 publications

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“…In contrast, BRASH syndrome typically involves beta blockers and calcium channel blockers, for which no routine blood monitoring is currently established [ 2 ]. A recently published case report documented, for the first time, the measurement of elevated serum levels of amlodipine in a case of BRASH syndrome [ 14 ], lending support to the hypothesis that BRASH syndrome may manifest owing to supratherapeutic drug levels [ 15 , 16 ]. This observation could explain the persistent bradycardia observed in some patients despite the normalization of potassium levels [ 17 ].…”

Section: Discussionmentioning

confidence: 83%

Not only Van Gogh: a case of BRASH syndrome with concomitant digoxin toxicity

Costantini,

Mantelli,

Carollo

et al. 2024

J Med Case Reports

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Background Bradycardia, renal failure, atrioventricular (AV) node blocking, shock, and hyperkalemia syndrome is a potentially life-threatening clinical condition characterized by bradycardia, renal failure, atrioventricular (AV) node blocking, shock, and hyperkalemia. It constitutes a vicious circle in which the accumulation of pharmacologically active compounds and hyperkalemia lead to hemodynamic instability and heart failure. Case presentation A 66-year-old Caucasian female patient was admitted to the emergency department presenting with fatigue and bradycardia. Upon examination, the patient was found to be anuric and hypotensive. Laboratory investigations revealed metabolic acidosis and hyperkalemia. Clinical evaluation suggested signs of digoxin toxicity, with serum digoxin concentrations persistently elevated over several days. Despite the implementation of antikalemic measures, the patient’s condition remained refractory, necessitating renal dialysis and administration of digoxin immune fab. Conclusion Bradycardia, renal failure, atrioventricular (AV) node blocking, shock, and hyperkalemia syndrome is a life-threatening condition that requires prompt management. It is important to also consider potential coexisting clinical manifestations indicative of intoxication from other pharmacological agents. Specifically, symptoms associated with the accumulation of drugs eliminated via the kidneys, such as digoxin. These manifestations may warrant targeted therapeutic measures.

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