Digitalis Purpurea toxicity (cardiac poison)

digitalis purpurea toxicity

1. Digitalis Purpurea (Cardiac Poision ) By Dr. Muhammad Zeeshan Marwat Dept. of Forensic Medicine , BMC, Bannu

2. Key points Introduction Signs and symptoms Toxicity Fetal and Lethal doses Diagnosis Treatment Postmortem Appearance Medicolegal Aspects digitalis toxicity 2

3. Introduction Digitalis purpurea is a species of flowering plant in the plantae family situated in north america and other temperate regions. The plant are well known source of heart medicine Digoxin which is used therapeutically in different heart diseases. Excessive ingestion of this plant can cause posioning and thts why called cardiac poison because it directly effect heart. digitalis toxicity 3

4. Introduction (cont’d) Synonym: Digitalis / Foxglove/lady glove Active principles(alkaloids) All are glycosides Digitoxin Digoxin Ditoxin digitalis toxicity 4

5. Signs and Symptoms digitalis toxicity 5

6. Toxicity Digitalis overdose can occur as a result of chronic toxicity or less commonly, as an acute manifestation The signs and symptoms are same in both.( acute+chronic ) One important difference is that in the Acute form there is usually hyperkalemia(loss of p wave,tall tented T wave, wide QRS Complex) Chronic form there is hypokalemia( pronlonged PR interval, T wave depression, U wave) digitalis toxicity 6

7. Fatal Doses and Fetal Period Fetal Doses: Digitoxin 03 mg Digoxin 15 mg Digitalis 02 mg Fetal Periods: Fatal period varies from half an hour to 24 hours digitalis toxicity 7

8. Diagnosis Estimation of plasma digoxin level(normal level 0.5-0.9 ng (radioimmunoassay) ECG Changes( hyperkalemia,hypokalemia , atrial fibrillation) digitalis toxicity 8

9. Treatment Decontamination: The stomach should be washed with a solution of tannic acid(Decrease effectiveness). If parts of the plant have been taken, bowel should be evacuated using lactulose( Duphalac ) ECG Monitoring Correction of cardiovascular abnormalities with drugs like phenytoin & lidocaine. AV block usually responds to atropine ( 0.6 mg hypodermically) Correction of fluid and electrolyte imbalances. Trisodium EDTA may help lower serum calcium and potassium……. Potassium chloride in a dose of 1 – 2 gms three times a day may be given by mouth provided the kidney function is normal digitalis toxicity 9

10. Treatment (cont’d) Antiglycoside antibodies , if available. Diuretics particulary chlorothizide should be avoided If the victim survives for 24 hours, recovery is usual. digitalis toxicity 10

11. Postmortem Appearances No specific signs. There may be gastric irritation of gastric mucosa and digitalis leaves or seeds may be found in the stomach. The seeds are reddish brown, remarkable small and somewhat angular in shape with peculiar markings. Lungs are also often congested digitalis toxicity 11

12. Medicolegal Importance Most cases of poisoning are accidental arising out of therapeutic overdose Suicidal ingestion is rare. Though digitalis is quite suitable as a homicidal poison, murder with this drug is uncommon. digitalis toxicity 12

13. digitalis toxicity 13 Thank you