Massive Intravenous Digoxin Overdosage

Abstract

ACCIDENTAL or intentional oral digoxin overdosage occurs in persons with and without underlying heart disease. We recently observed a laboratory technician without prior heart disease who self-adminstered 200 mg of digoxin intravenously. Since physicians rarely order more than 100 0.25-mg tablets of digoxin per prescription, oral ingestion of more than 25 mg would be expected to be rare. Reported digoxin ingestions have not exceeded 23 to 24 mg.^{1 2} In our patient severe hyperkalemia (potassium level of 13.5 mEq per liter) developed. Inexcitability of cardiac tissue occurred despite adequate control of plasma potassium with hemodialysis and magnesium infusion.Case ReportA . . .