Hemoperfusion in the Management of Digoxin Toxicity

Smiley, Joseph W.

doi:10.1001/jama.1978.03290250040024

Cited by 36 publications

(4 citation statements)

References 8 publications

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“…[2] However, digoxin can be effectively removed by hemoperfusion with charcoal or resin filters. [3] We successfully used charcoal hemoperfusion for specific treatment of digoxin overdose in this patient, as evident by the rapid decline in serum digoxin levels.…”

Section: Discussionmentioning

confidence: 99%

Severe suicidal digoxin and propranolol toxicity with insulin overdose

Garg

Panda

Dalvi

et al. 2014

Indian Journal of Critical Care Medicine

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We present a case of a 32-year-old male doctor, with type I diabetes mellitus on daily insulin therapy, who allegedly consumed large doses of digoxin and propranolol along with simultaneous administration of large dose of insulin with suicidal intent. Initial investigations revealed serum digoxin levels of 7.5 ng/ml, serum insulin 500 μIU/ml, and serum C-peptide 0.43 ng/ml. He was managed with charcoal-based hemoperfusion for digoxin overdose along with injection glucagon for propranolol overdose. His blood sugar levels were maintained with continuous infusion of 20% dextrose till the patient was allowed to take oral diet. Significant clinical improvement was noticed with this therapy which was evident by progressively declining serum digoxin levels, normalization of pulse rate, and adequate blood glucose levels. Finally, with a good hemodynamic profile and a serum digoxin level well within normal limits, he was discharged following consultation with a psychiatrist.

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Section: Discussionmentioning

confidence: 99%

Severe suicidal digoxin and propranolol toxicity with insulin overdose

Garg

Panda

Dalvi

et al. 2014

Indian Journal of Critical Care Medicine

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“…[11] Even though there are reservations regarding its use in digoxin overdose,[7] resin hemoperfusion may be tried for drugs like digoxin, which have a high lipid solubility and it has been used successfully in a few cases. [9–11]…”

Section: Discussionmentioning

confidence: 99%

Severe suicidal digoxin toxicity managed with resin hemoperfusion: A case report

Juneja

Singh

Bhasin

et al. 2012

Indian Journal of Critical Care Medicine

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Owing to its wide and easy availability, digoxin has got a significant abuse potential and may be used for suicidal purposes. Digoxin-specific antibody (Fab) fragments have become the mainstay of therapy for severe digoxin toxicity and have significantly helped in reducing mortality. However, due to its high cost and limited availability alternative measures may need to be used to manage severe intoxications especially in countries like India, where Fab fragments are unavailable. Here, we present a case of a young female who presented to our casualty with alleged history of consumption of 17.5 mg of digoxin tablets. After admission to ICU, she developed atrioventricular blocks with hemodynamic instability which had to be managed with temporary pacemaker. Her serum digoxin levels were high (12.63 ng/ml) and in the absence of Fab fragments, resin hemoperfusion was done which drastically reduced the serum digoxin levels and reverted the symptoms.

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“…131,132 For more information, please refer to Chapter 5. Macrolides and tetracyclines increase the risk of digoxin toxicity and should be used with caution.…”

Section: Digoxinmentioning

confidence: 99%