Gastrointestinal symptoms as an important sign in premature newborns with severely increased S-digoxin.
The aim is to emphasize the importance of extracardiac symptoms of digoxin intoxication in newborns. The most common intoxication symptoms in adults are of cardiac origin, but due to altered symptomatology, digoxin overdose in infants are not always discovered on symptomatic basis. In preterm infants, this is even more pronounced due to diminished digoxin sensitivity. Also, tissue distribution is altered in newborns, which, combined with the need for higher doses in newborns to obtain clinical effect, underscores the need for the utmost care, when newborns receive digoxin treatment to avoid intoxication. We report a case of severe digoxin intoxication in a preterm newborn infant, leading to distinct gastrointestinal symptoms, but only minor cardiac affection. The literature concerning digoxin intoxication and digoxin measurement is reviewed to elucidate the case report. In conclusion, alertness should be drawn to extracardiac symptoms of digoxin intoxication, especially in newborns, and P-Potassium can serve as a predictor and thereby strengthen any given suspicion. Therapeutic drug monitoring should be performed, as soon as digoxin overdose due to the above-mentioned signs is suspected in spite of vague cardiac symptoms.
Nybo
Mads
M
Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, DK-5000 Odense, Denmark. mads.nybo@ouh.fyns-amt.dk
Damkier
Per
P
D015746:Abdominal Pain; D000889:Anti-Arrhythmia Agents / Q000097:blood / Q000506:poisoning*; D004077:Digoxin / Q000097:blood / Q000506:poisoning*; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis / Q000601:surgery; D041981:Gastrointestinal Tract / Q000187:drug effects*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D009325:Nausea; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000188:drug therapy; D014839:Vomiting
D000889:Anti-Arrhythmia Agents; D004077:Digoxin