Digoxin overdose
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Olfactory, taste and vision disorders: case report A 62-year-old man experienced olfactory, taste and vision disorders due to digitalism while receiving digoxin. The man had been receiving digoxin 0.25 mg/day [therapeutic indication not stated] for 10 years when he presented to an ophthalmology department with a 1-month history of xanthopsia and photophobia. His right and left eyesight were 0.2 and 0.5, respectively. His concomitant medications comprised itraconazole, levothyroxine sodium, warfarin, candesartan cilexetil, isosorbide dinitrate, furosemide, lansoprazole and sodium ferrous citrate. Three days later tests indicated optic nerve dysfunction; retrobulbar neuritis and suspected optic nerve inflammation due to sinusitis was diagnosed. The man’s eyesight continued to deteriorate and 6 days later steroid pulse therapy was started to prevent blindness. Investigation of his paranasal sinuses revealed slight sinusitis, but of insufficient severity to induce optic nerve inflammation. Seven days later his eyesight had decreased to 0.05 in the right and 0.04 in the left, and he complained of a taste disorder since his vision disorders began. He had a digoxin level of 4.3 ng/mL, indicating digitalism, and steroid pulse therapy was withdrawn. Eight days later the man had a digoxin level of 6 ng/mL, despite digoxin therapy being stopped. Tests showed increased threshold levels in the bilateral chorda tympanic, glossopharyngeal and greater petrosal nerve areas. Ten days later he complained of smell disturbances since his vision disorders began, and tests revealed olfactory loss with a slightly increased detection olfactory threshold and a greatly increased cognitive olfactory threshold. Thirteen days later the man’s digoxin level had normalised at 1.9 ng/mL and after 16 days the sweet and bitter threshold levels of the bilateral chorda tympanic area and the right glossopharyngeal area of the tongue had decreased. His vision recovered to normal levels 19 days later and a further 23 days later his detection and cognitive olfactory losses recovered; however, his sour taste was not recovered. Author comment: "Because the olfactory and gustatory disturbances were related to the serum digoxin level, these disturbances were possibly introduced by an overdose of digoxin." Ishimaru T, et al. Olfactory and gustatory disturbances caused by digitalism: a case 801045961 report. Auris Nasus Larynx 33: 465-469, No. 4, Dec 2006 - Japan
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Reactions 9 Dec 2006 No. 1131
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