Search

Background: Digoxin is a cardiac glycoside that is frequently prescribed in atrial fibrillation and heart failure. Symptoms such as nausea, hyperkalaemia, cardiac arrhythmias and cardiac arrest are seen in digoxin toxicity. The treatment focuses on reduction of digoxin absorption, prevention of hypokalaemia and hyperkalaemia, treatment of symptoms and, in severe toxicity, administration of digoxin antibodies., Case Description: A 73-year-old man with a history of extensive cardiac disease was seen 45 minutes after ingesting 20 mg of digoxin. The patient developed ventricular fibrillation within 3 hours of ingestion, before arrival of the digoxin antibodies. The patient passed away despite resuscitation and administration of an insufficient amount of digoxin antibodies., Conclusion: The national supply of digoxin antibodies in the Netherlands proved to be too limited for the treatment of a patient with severe digoxin toxicity. An increase in the supply, and central storage, of digoxin antibodies could promote faster administration of an adequate amount of the antibodies. Timely transportation to an extra corporeal membrane oxygenation centre should also be considered.

Agranulocytosis is a rare but dreaded side-effect of thiamazole. A 61-year-old woman presented at the emergency department with fever and dyspnoea. Because she had recently started therapy with thiamazole for hyperthyroidism, a case of agranulocytosis was feared. Laboratory findings did indeed reveal an absolute neutrophil count of zero. Broad-spectrum antibiotics were given immediately, granulocyte-colony stimulating factor was started and she was admitted to the ICU for supportive care. Unfortunately, she died a day after admission. In this case report, we wanted to place the focus on the importance of this severe side-effect. We emphasize the value of warning the patient, preferably in writing, about the risk of agranulocytosis. We also draw attention to the fact that every doctor must know about agranulocytosis. In this case, the patient consulted her family doctor because she had a sore throat and fever, but was admitted to the hospital only three days after the onset of the symptoms. We believe the risk of agranulocytosis should be understood by every doctor and that the publication of many cases such as this could help heighten general awareness of possibly fatal side-effects like agranulocytosis.