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. 1970 Oct;113(4):1–7.

Production, Recognition and Treatment of Digitalis Intoxication

Arthur Selzer, Keith E Cohn
PMCID: PMC1501599  PMID: 5479347

Abstract

Recent studies dealing with absorption, distribution in the body and fate of digitalis, have provided a basis for better understanding the great variability of individual responses to this drug. When given to patients in sinus rhythm as a cardiotonic agent, digitalis action cannot be accurately assessed nor monitored by appropriate tests; consequently, blind administration of the drug on average dosages inevitably produces digitalis intoxication in a proportion of patients. Clinical signs of digitalis toxicity, factors enhancing its development, its recognition and treatment are summarized here. It is emphasized that digitalis should always be administered as a calculated risk, when benefits are clearly defined, as in overt cardiac failure and in atrial fibrillation associated with excessive ventricular rates. Use for other indications, particularly prophylactic, should be considered experimental and is to be discouraged.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. CRAIG L. C., LOWN B., LEVINE S. A. Resistance and sensitivity to digitalis. J Am Med Assoc. 1958 Apr 26;166(17):2139–2144. doi: 10.1001/jama.1958.02990170037009. [DOI] [PubMed] [Google Scholar]
  2. Cohn K. E., Kleiger R. E., Harrison D. C. Influence of potassium depletion on myocardial concentration of tritiated digoxin. Circ Res. 1967 May;20(5):473–476. doi: 10.1161/01.res.20.5.473. [DOI] [PubMed] [Google Scholar]
  3. DOHERTY J. E., PERKINS W. H., MITCHELL G. K. Tritiated digoxin studies in human subjects. Arch Intern Med. 1961 Oct;108:531–539. doi: 10.1001/archinte.1961.03620100023004. [DOI] [PubMed] [Google Scholar]
  4. DOHERTY J. E., PERKINS W. H., WILSON M. C. STUDIES WITH TRITIATED DIGOXIN IN RENAL FAILURE. Am J Med. 1964 Oct;37:536–544. doi: 10.1016/0002-9343(64)90067-1. [DOI] [PubMed] [Google Scholar]
  5. DUBNOW M. H., BURCHELL H. B. A COMPARISON OF DIGITALIS INTOXICATION IN TWO SEPARATE PERIODS. Ann Intern Med. 1965 May;62:956–965. doi: 10.7326/0003-4819-62-5-956. [DOI] [PubMed] [Google Scholar]
  6. Deutsch S., Dalen J. E. Indications for prophylactic digitalization. Anesthesiology. 1969 Jun;30(6):648–656. doi: 10.1097/00000542-196906000-00016. [DOI] [PubMed] [Google Scholar]
  7. Doherty J. E., Perkins W. H. Digoxin metabolism in hypo- and hyperthyroidism. Studies with tritiated digoxin in thyroid disease. Ann Intern Med. 1966 Mar;64(3):489–507. doi: 10.7326/0003-4819-64-3-489. [DOI] [PubMed] [Google Scholar]
  8. Friedberg H. D. Atrial fibrillation and digitalis toxicity. Am Heart J. 1969 Mar;77(3):429–430. doi: 10.1016/0002-8703(69)90201-4. [DOI] [PubMed] [Google Scholar]
  9. Gotsman M. S., Schrire V. Toxicity--a frequent complication of digitalis therapy. S Afr Med J. 1966 Jul 9;40(25):590–592. [PubMed] [Google Scholar]
  10. Jelliffe R. W. An improved method of digoxin therapy. Ann Intern Med. 1968 Oct;69(4):703–717. doi: 10.7326/0003-4819-69-4-703. [DOI] [PubMed] [Google Scholar]
  11. Jelliffe R. W., Buell J., Kalaba R., Sridhar R., Rockwell R., Wagner J. G. An improved method of digitoxin therapy. Ann Intern Med. 1970 Apr;72(4):453–464. doi: 10.7326/0003-4819-72-4-453. [DOI] [PubMed] [Google Scholar]
  12. Juler G. L., Stemmer E. A., Connolly J. E. Complications of prophylactic digitalization in thoracic surgical patients. J Thorac Cardiovasc Surg. 1969 Sep;58(3):352–360. [PubMed] [Google Scholar]
  13. Kastor J. A., Yurchak P. M. Recognition of digitalis intoxication in the presence of atrial fibrillation. Ann Intern Med. 1967 Nov;67(5):1045–1054. doi: 10.7326/0003-4819-67-5-1045. [DOI] [PubMed] [Google Scholar]
  14. Kleiger R., Lown B. Cardioversion and digitalis. II. Clinical studies. Circulation. 1966 Jun;33(6):878–887. doi: 10.1161/01.cir.33.6.878. [DOI] [PubMed] [Google Scholar]
  15. LOWN B., SALZBERG H., ENSELBERG C. D., WESTON R. E. Interrelation between potassium metabolism and digitalis toxicity in heart failure. Proc Soc Exp Biol Med. 1951 Apr;76(4):797–801. doi: 10.3181/00379727-76-18636. [DOI] [PubMed] [Google Scholar]
  16. Lown B. Electrical stimulation to estimate the degree of digitalization. II. Experimental studies. Am J Cardiol. 1968 Aug;22(2):251–259. doi: 10.1016/0002-9149(68)90231-2. [DOI] [PubMed] [Google Scholar]
  17. Luchi R. J., Gruber J. W. Unusually large digitalis requirements. A study of altered digoxin metabolism. Am J Med. 1968 Aug;45(2):322–328. doi: 10.1016/0002-9343(68)90049-1. [DOI] [PubMed] [Google Scholar]
  18. MOSER R. H. Diseases of medical progress. N Engl J Med. 1956 Sep 27;255(13):606–614. doi: 10.1056/NEJM195609272551306. [DOI] [PubMed] [Google Scholar]
  19. Morris J. J., Jr, Taft C. V., Whalen R. E., McIntosh H. D. Digitalis and experimental myocardial infarction. Am Heart J. 1969 Mar;77(3):342–355. doi: 10.1016/0002-8703(69)90190-2. [DOI] [PubMed] [Google Scholar]
  20. Ogden P. C., Selzer A., Cohn K. E. The relationship between the inotropic and dromotropic effects of digitalis: the modulation of these effects by autonomic influences. Am Heart J. 1969 May;77(5):628–635. doi: 10.1016/0002-8703(69)90547-x. [DOI] [PubMed] [Google Scholar]
  21. RODENSKY P. L., WASSERMAN F. Observations on digitalis intoxication. Arch Intern Med. 1961 Aug;108:171–188. doi: 10.1001/archinte.1961.03620080003002. [DOI] [PubMed] [Google Scholar]
  22. SOMLYO A. P. The toxicology of digitalis. Am J Cardiol. 1960 Apr;5:523–533. doi: 10.1016/0002-9149(60)90111-9. [DOI] [PubMed] [Google Scholar]
  23. Smith T. W., Butler V. P., Jr, Haber E. Determination of therapeutic and toxic serum digoxin concentrations by radioimmunoassay. N Engl J Med. 1969 Nov 27;281(22):1212–1216. doi: 10.1056/NEJM196911272812203. [DOI] [PubMed] [Google Scholar]
  24. WHEAT M. W., Jr, BURFORD T. H. Digitalis in surgery: extension of classical indications. J Thorac Cardiovasc Surg. 1961 Feb;41:162–168. [PubMed] [Google Scholar]
  25. Wycoff C. C. New concepts of digitalis. Calif Med. 1969 Dec;111(6):423–432. [PMC free article] [PubMed] [Google Scholar]

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