Gastrointestinal Symptoms as an Important Sign in Premature Newborns with Severely Increased S‐Digoxin

Nybo, Mads; Damkier, Per

doi:10.1111/j.1742-7843.2005.pto_96609.x

Cited by 8 publications

(2 citation statements)

References 24 publications

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“…Gastrointestinal symptoms such as nausea, vomiting, diarrhea and abdominal pain are predominant and frequently observed in infants. 15 The most common symptoms in this study were vomiting, lethargy, and apnea.…”

Section: Discussionmentioning

confidence: 64%

Clinical signs and symptoms of toxic serum digoxin levels in neonates

et al. 2019

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Digoxin is widely used in the treatment of congestive heart failure and some arrhythmias. Digoxin toxicity may occur easily because digoxin has a narrow therapeutic index. This retrospective study was conducted to evaluate the clinical signs and symptoms of toxic serum digoxin levels in neonates. Medical reports of the neonates who had serum digoxin concentrations >2 nanogram/milliliter (ng/ml) were reviewed in terms of patient demographics, serum digoxin concentrations, signs and symptoms of digoxin toxicity, serum digoxin and electrolyte levels, renal function tests, electrocardiograms, echocardiography, and treatments applied. Digoxin toxic levels were identified in the 13 neonates. Of the 13 neonates with digoxin toxic level, 9 (69%) were term and 8 (62%) were female. Twenty-three percent (3/13) of newborn infants were symptomatic. Symptomatic patients had statistically significantly higher serum digoxin levels, at 7.76±2.76 (5.4-10.8) ng/ml, than asymptomatic patients, at 3.31±1.09 (2.02-4.95) (p=0.036). Symptoms related to toxic digoxin levels were observed in the three neonates with plasma digoxin levels >5 ng/ml. Gastrointestinal and central nervous system symptoms were the major clinic findings. Despite high digoxin levels, no digoxin-related arrhythmia was observed on electrocardiography, other than sinus bradycardia. Two premature neonates were treated with digoxin-specific antibody Fab fragments (DigiFab ®) and hypokalemia developed in both of them. Our data suggests that symptoms related with digoxin toxic levels were observed in neonates with plasma digoxin levels >5 ng/ml. Serum digoxin levels should be measured in case of signs and symptoms of digoxin toxicity or risk factors for such toxicity.

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Section: Discussionmentioning

confidence: 64%

Clinical signs and symptoms of toxic serum digoxin levels in neonates

et al. 2019

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“…Although the most common symptoms of digitalis toxicity are related to the cardiovascular system in adults, intestinal and neural networks are the most affected. 23 Digitalis toxicity can even cause life-threatening symptoms 24 such as fatal arrhythmia, SAH, and dangerous BBB destruction. Digitalis toxicity can include complications of the urinary, cardiovascular, respiratory, and central nervous systems.…”

Section: Discussionmentioning

confidence: 99%

Destructive effect of digitalis overdose on blood-brain barrier in rats; an experimental study

et al. 2020

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Introduction: Cardiac glycosides are widely used in critical cardiac diseases despite their unexplained mechanisms on cardio-respiratory system and other autonomic complications within both intra-uterine and post-natal life. The aim of this study is to investigate if digitalis overdose could cause a result in such complications by a destructive effect on blood-brain barrier (BBB). Methods: Twenty-five male Sprague Dawley rats weighing 300-350 g were divided into the following groups: control (n=5), sham (isotonic) (n=5), therapeutic dose (n=5), arrhythmogenic dose (n=5), and lethal dose (n=5). The animals were euthanized and their brains were extracted. The brains were histopathologically and immunohistochemically examined to evaluate BBB morphology in the superior temporal cortex. Results: One animal died because of experimental procedures on the first day. Macroscopic examination of brains revealed brain edema, subarachnoid hemorrhage (SAH), and narrowed cisterns in toxic doses of digitalis-treated animals. Brain histopathological examination of these groups revealed bloody subarachnoid and cisternal spaces, cortical arteriolar vasospasm, neurodegeneration, and even peri-arteriolar neuroglial component fragmentation; these changes induced BBB destruction in the high-dose digitalis-treated animals. Conclusion: Digitalis should not be used with overdoses if the cardio-respiratory arrhythmia is unexpectedly appearing in low doses against the possibility of defected or disrupted BBB.

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Drug monographs

2014

Neonatal Formulary 7

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Gastrointestinal Symptoms as an Important Sign in Premature Newborns with Severely Increased S‐Digoxin

Cited by 8 publications

References 24 publications

Clinical signs and symptoms of toxic serum digoxin levels in neonates

Clinical signs and symptoms of toxic serum digoxin levels in neonates

Destructive effect of digitalis overdose on blood-brain barrier in rats; an experimental study

Drug monographs

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