Non-cardiac symptoms of digitalis intoxication

Lely, A.H.; Enter, C. H. J. Van

doi:10.1016/0002-8703(72)90132-9

Cited by 75 publications

(12 citation statements)

References 16 publications

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“…visual symptoms (Beller et al, 1971;Lely & Van Enter, 1972). In the present study, however, flicker abnormalities were detected as often as were electrocardiographic signs indicating definite digitalis toxicity.…”

Section: Discussioncontrasting

confidence: 53%

“…Those effects on the central nervous system seem to be less common than cardiac arrhythmias or gastrointestinal effects; they have been reported in 5 to 15% of intoxicated patients and they occur mainly after severe overdosage, but they may have been underestimated (Lely & Van Enter, 1972;Storstein et al, 1977). The central effects of digitalis glycosides were investigated in a small number of subjects by means of flicker fusion tests, but these studies gave conflicting results (Gibson et al, 1965;Robertson et al, 1966;Towbin et al, 1967).…”

Section: Methodsmentioning

confidence: 99%

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Effect of digoxin on the sensitivity to flickering light.

Guignard¹,

Toi²,

Burckhardt³

et al. 1983

Brit J Clinical Pharma

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1 The sensitivity to flickering light at various light frequencies (DeLange curve) was determined in 20 controls and 45 patients receiving maintenance doses of digoxin. 2 Flicker thresholds (mean percentage of maximal light modulation + s.d.; F 30 Hz) were 7.6 + 1.7 in controls and 9.4 ± 1.7 in patients with optimal plasma digoxin levels (0.5-1.9 ng/ml), but they rose to 15.5 + 1.9 at subtoxic levels (2.0-3.0 ng/ml), and to 21.8 + 2.6 at toxic levels (above 3.0 ng/ml). 3 Flicker sensitivity was inversely correlated with plasma digoxin levels and returned to baseline values when the administration of digoxin was interrupted. 4 The DeLange curve seems to be a valuable tool to measure the toxic effects of digitalis on the visual system.

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Section: Discussioncontrasting

confidence: 53%

Section: Methodsmentioning

confidence: 99%

Effect of digoxin on the sensitivity to flickering light.

Guignard¹,

Toi²,

Burckhardt³

et al. 1983

Brit J Clinical Pharma

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“…Slične efekte prave i ostali antihipertenzivi sa centralnim delovanjem kao što je klonidin ili ranije mnogo korišćeni rezerpin. Digoksin je lek poznat po izazivanju toksičnih manifestacija od strane CNS-a, tako da su nastanak delirijuma ili demencije, pouzdani znaci predikcije trovanja digoksinom [37]. Od ostalih kardioloških lekova treba imati povećani oprez kod korišćenja beta blokatora propranolola i antiaritmika amiodarona.…”

Section: Kvs Lekoviunclassified

Delirium: Focus on the drugs

Mitrović¹,

Stojkov²,

Radonjić³

et al. 2015

Engrami

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UVODStanje delirijuma imalo tokom istorije mnogo izmena i opisa. Termin ,,akutno konfuzno stanje" je generalno prihvatljivo u skoro svim definicijama koje su vezane za delirijum. Organska etoiopatogeneza nastanka delirijuma je vezana za akutni nastanak i uticaj spoljašnjih faktora. Pored mnogih mogućih uzročnika delirijuma, uticaj lekova na njegov razvoj je poznat. Kratak sadržajDelirijum je kompleksna pojava sa širokom lepezom simptoma i znaka od strane centralnog nervnog sistema. Osnovna karakteristika delirijuma je pomućenje svesti. Češće se javlja kod starijih osoba na hospitalnom lečenju. Ključne karakteristike delirijumskih stanja je njihov brz i agresivan početak, uzročnici su dominantno egzogeni, sa jasno izmenjenim stanjem svesti i pažnje, prisustvom halucinacija uz najčešće izraženo pogrešno predstavljanje opažanja. Epidemiološki podaci jasno ukazuju da vulnerabilni deo populacije čine stariji hospitalizovani pacijenti, posebno oni koji su izloženi ortopedskim operacijama kuka ili operacijama na srcu. Ovaj deo populacije, shodno godinama, uobičajeno koristi različite medikamente, od kojih pojedini mogu imati potencijala za razvoj delirijuma. Različiti lekovi imaju različite potencijale za nastanak delirijumskog stanja, pa je zato bitno dobro poznavati one koji imaju jasno definisane i opisane delirijumske potencijale (antiholinergički lekovi, hipnotici, antidepresivi, analgetici). Poznavanje ovog potencijala može dati značajnu prednost lekaru prilikom donošenja odluke za primenu određene grupe lekova, posebno u hospitalnim uslovima, a takođe i u bržem prepoznavanju simptomatologije delirijumskih stanja kod pacijenata koji su tokom hospitalizacije ili posle hiruških intrevencija upali u delirijumsko stanje. Postojanje protokola za dijagnostikovanje delirijuma, kao i dobro obučenog zdravstvenog osoblja za prepoznavanje i lečenje delirijumskih stanja, je važan preduslov kako za efikasnu borbu protiv nastanka delirijuma, tako i za saniranje njegovih posledica.

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“…The blood-brain barrier acts as a regulatory interface between blood and the central nervous system (13,14,22,33,40), the brain and the cerebrospinal fluid (CSF) being the main compartments. Drugs pass into the central nervous system via the brain capillaries.…”

Section: Introductionmentioning

confidence: 99%

Studies on digitalis. 23. Blood‐brain barrier of digitoxin in humans

Storstein¹,

Nore²,

Sjaastad³

1979

Clinical Cardiology

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Summary: Data on the cerebrospinal fluid concentrations of digitoxin in man have been lacking. Aim of the present study was to investigate serum and cerebrospinal fluid concentrations of digitoxin. Eleven patients with normal cerebrospinal fluid composition, normal serum albumin values, normal renal and hepatic function and normal hematologic tests were given a single dose of 0.6 mg digitoxin. Serum and cerebrospinal fluid were collected 16 h after the dose, and assayed by radio-immunoassay, serum digitoxin protein binding was measured with equilibrium dialysis.Mean serum digitoxin concentration was 12.4 ng/ml (SO 2.6) and mean CSF concentration 0.84 ngiml (SO 0.22) giving a CSF/serum ratio of 0.07 (SO 0.03). Serum digitoxin protein binding was 97.4% (SO 0.4) and the calculated CSF/free serum digitoxin ratio was thus 2.94 (SO 1.43).Free serum digitoxin concentrations are more relevant for pharmacologic effect than total serum digitoxin concentrations and also for passage into the central nervous system. Using free drug concentrations the ratio between digitoxin in serum and CSF is lower than reported values for digoxin indicating a higher penetrance of digitoxin into the central nervous system. This corresponds well with the higher lipid solubility of digitoxin. Post mortem studies have shown that concentrations are higher in cerebral tissue than in CSF for digoxin. Determination of CSF concentrations thus probably underestimates the penetrance of digitalis glycosides into the central nervous system, but may serve as a useful indicator of variance among digitalis glycosides.

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Non-cardiac symptoms of digitalis intoxication

Cited by 75 publications

References 16 publications

Effect of digoxin on the sensitivity to flickering light.

Effect of digoxin on the sensitivity to flickering light.

Delirium: Focus on the drugs

Studies on digitalis. 23. Blood‐brain barrier of digitoxin in humans

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