title: [Reversible thrombocytopenia due to digitoxin overdose].
abstract: A 65-year-old woman, known to have peptic ulcers, developed nausea and retching. Clinical examination demonstrated pain on pressure in the epigastrium with otherwise normative findings for age. Two gastric ulcers and gastritis with erosions were seen at endoscopy. The patient, who was being treated with digitoxin for heart failure, reported having taken up to four digitoxin tablets (0.07 mg each) daily because she had insomnia. The plasma digitoxin level was between 150 and 160 nmol/l (therapeutic range 17-33 nmol/l), while the ECG showed no signs of digitalis intoxication. Initially the platelet count was 40,000/microliter: there had been no history of thrombocytopenia or symptoms of abnormal haemostasis. Other laboratory tests were within normal limits. After digitoxin had been discontinued, the platelet count rose without further treatment to 373,000/microliter 3 weeks after hospital admission by which time the digitoxin level had fallen to 48.9 nmol/l. The gastrointestinal symptoms regressed completely on treatment with omeprazole (40 mg three times daily for 8 days) and ranitidine (150 mg twice daily).
authors.affiliation: Klinische Pharmakologie und Therapie, Technische Universität Dresden.
authors.forename: J
authors.initials: J
authors.lastname: Krappweis
authors.forename: G
authors.initials: G
authors.lastname: Petereit
authors.forename: K U
authors.initials: KU
authors.lastname: Schentke
authors.forename: W
authors.initials: W
authors.lastname: Kirch
mesh_terms: D000368:Aged; D004074:Digitoxin / Q000009:adverse effects*; D062787:Drug Overdose; D005260:Female; D005756:Gastritis / Q000150:complications / Q000188:drug therapy; D005773:Gastroscopy; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D009325:Nausea; D009853:Omeprazole / Q000627:therapeutic use; D010976:Platelet Count / Q000187:drug effects; D011899:Ranitidine / Q000627:therapeutic use; D013276:Stomach Ulcer / Q000150:complications / Q000188:drug therapy; D013921:Thrombocytopenia / Q000139:chemically induced*; D014839:Vomiting
chemical_list: D011899:Ranitidine; D004074:Digitoxin; D009853:Omeprazole
vernacular_title: Reversible Thrombozytopenie bei Digitoxinüberdosierung.