Acute, Massive Poisoning with Digitoxin: Report of Seven Cases and Discussion of Treatment

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Abstract
Severe digitoxin poisoning in 7 patients was reported. Doses were 2-20 mg and maximal plasma concentrations were 50-237 nmol/l. One patient died from ventricular fibrillation and the course in another was protracted due to severe complications. The course in all patients was more dependent on underlying heart disease than on plasma digitoxin concentration. Gastric aspiration and lavage followed by instillation of activated charcoal after drug intake was proposed. In order to interrupt the enterohepatic circulation of digitoxin, repeated doses of charcoal should be given. Charcoal is preferable to cholestyramine because of its better tolerability. Ventricular arrhythmias should not be treated unless they are serious because most antiarrhythmic drugs may impede AV[atrioventricular]-conduction. Phenytoin is the drug of choice because the AV-conduction is less affected or even improved and metabolism of digitoxin is accelerated. Conduction disturbances with bradycardia are frequently seen and may occur suddenly. Prophylactic introduction of a transvenous pacing catheter is recommended as a routine procedure.