Case report on the interaction between furosemide and digoxin that caused digoxin toxicity
Abstract
Toxicity from digitalis is a typical clinical issue. In this case, the interaction of digoxin and furosemide is becoming more widely recognised as a major cause of digitalis toxicity. We present an abnormal ECG that demonstrates digoxin-induced cardiotoxicity. We report a case of a Digoxin toxicity in a 79-year-old male patient admitted with complains of nausea, increase frequency of micturition, decrease appetite, increase nocturia, shortness of breathing. The patient is taking furosemide and digoxin as past medication for Heart block and Chronic kidney disease treatment. In patient, Serum digoxin level is high due to hypokalemia because of digoxin and furosemide drug interaction. The Electrocardiogram interpretation shows sinus bradycardia, ST segment depression, and T wave inversion which mainly due to digoxin toxicity. So for the management digoxin is omitted from the current treatment. The patient needs to be constantly monitored since digitalis poisoning is deadly. A digoxin-binding antibody is the only treatment for digoxin overdose that can reverse its effects by its antidote but it’s not available. So, the most successful course of treatment is symptomatic or efficient methods of extracorporeal drug removal.
Keywords: Digoxin toxicity, furosemide, hypokalemia, cardiotoxicity, complete heart block, ST segment depression.
Keywords:
Digoxin toxicity, furosemide, hypokalemia, cardiotoxicity, complete heart block, ST segment depressionDOI
https://doi.org/10.22270/jddt.v12i5-S.5717References
Bridwell R. E, Baker K. A, Hoyte C. O, Patric C. Ng Digoxin Toxicity in a Patient with Pacemaker: A Case Report. Cureus. 2019; 11(11):e6056. https://doi.org/10.7759/cureus.6056
ARAVANIS C, MICHAELIDES G. Paroxysmal auricular flutter and right bundle branch block following digitalis therapy. Am J Cardiol. 1959; 4(1):124-7. https://doi.org/10.1016/0002-9149(59)90202-4
Morris SA, Hatcher HF, Reddy DK. Digoxin therapy for heart failure: an update. Am Fam Physician. 2006 Aug 15; 74(4):613-8.
Pincus M. Management of digoxin toxicity. Aust Prescr. 2016; 39(1):18-20. https://doi.org/10.18773/austprescr.2016.006
Haynes K, Heitjan D, Kanetsky P, Hennessy S. Declining public health burden of digoxin toxicity from 1991 to 2004. Clin Pharmacol Ther. 2008 Jul; 84(1):90-4. https://doi.org/10.1038/sj.clpt.6100458
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, et al. American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 15; 62(16):e147-239. https://doi.org/10.1016/j.jacc.2013.05.019
Acharya TA, Mehta DS, Vekariya RS. Digoxin toxicity: Crucial to diagnose. International Journal of Basic and Clinical Pharmacology. 2012; 1:39-40 https://doi.org/10.5455/2319-2003.ijbcp001012
Lloyd M. Digoxin-specific antibody fragments in the treatment of digoxin toxicity. J Emerg Med.2014 Sep-Oct; 52(8):824-36.https://doi.org/10.3109/15563650.2014.943907
Mordasini MR, Krähenbühl S, Schlienger RG. Appropriateness of digoxin level monitoring. Swiss Med Wkly. 2002 Sep 7; 132(35-36):506-12.
Wang MT, Su CY, Chan AL, Lian PW, Leu HB, Hsu YJ. Risk of digoxin intoxication in heart failure patients exposed to digoxin-diuretic interactions: a population-based study. Br J Clin Pharmacol. 2010 Aug; 70(2):258-67. https://doi.org/10.1111/j.1365-2125.2010.03687.x
Vanden Hoek TL, Morrison LJ, Shuster M, Donnino M, Sinz E, Lavonas EJ, Jeejeebhoy FM, Gabrielli A. Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010 Nov 02; 122(18 Suppl 3):S829-61. https://doi.org/10.1161/CIRCULATIONAHA.110.971069
Long B, Warix JR, Koyfman A. Controversies in Management of Hyperkalemia. J Emerg Med. 2018; 55(2):192-205. https://doi.org/10.1016/j.jemermed.2018.04.004
Negroni MS, Marengo A, Caruso D, Tayar A, Rubiolo P, Giavarini F, et al. A Case Report of Accidental Intoxication following Ingestion of Foxglove Confused with Borage: High Digoxinemia without Major Complications. Case Rep Cardiol. 2019 Nov 29; 2019:9707428. D https://doi.org/10.1155/2019/9707428
Grubb A, Mentz RJ. Pharmacological management of atrial fibrillation in patients with heart failure with reduced ejection fraction: review of current knowledge and future directions. Expert Rev Cardiovasc Ther. 2020 Feb; 18(2):85-101. https://doi.org/10.1080/14779072.2020.1732210
Mutlu M, Aslan Y, Kader Ş, Aktürk-Acar F, Dilber E. Clinical signs and symptoms of toxic serum digoxin levels in neonates. Turk J Pediatr. 2019; 61(2):244-249. https://doi.org/10.24953/turkjped.2019.02.013
Angraal S, Nuti SV, Masoudi FA, Freeman JV, Murugiah K, Shah ND. Digoxin Use and Associated Adverse Events Among Older Adults. Am J Med. 2019 Oct; 132(10):1191-1198. https://doi.org/10.1016/j.amjmed.2019.04.022
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