The influence of potassium ion (K+) on digoxin-induced inhibition of porcine cerebral cortex Na+/K+-ATPase

Experimental and theoretical insights of functionalized hexavanadates on Na+/K+-ATPase activity; molecular interaction field, ab initio calculations and in vitro assays

The influence of three functionalized hexavanadates (V₆): Na₂ [V₆O₁₃{(OCH₂)₃CCH₃}₂], [H₂]₂ [V₆O₁₃{(OCH₂)₃CCH₂OCOCH₂CH₃}₂] and [(C₄H₉)₄N]₂ [V₆O₁₃{(OCH₂)₃CCH₂OOC(CH₃)₂-COOH}₂ on Na⁺/K⁺-ATPase activity, was investigated in vitro. Including compounds already tested by Xu et al. (Journal of Inorganic Biochemistry 161 (2016) 27-36), all functionalized hexavanadates inhibit the activity of Na⁺/K⁺-ATPase in a dose-dependent manner but with different inhibitory potencies. Na₂ [V₆O₁₃{(OCH₂)₃CCH₃}₂] was found to have the best inhibition properties - showing 50% inhibition IC₅₀ = 5.50 × 10^-5 M, while [(C₄H₉)₄N]₂ [V₆O₁₃{(OCH₂)₃CCH₂OOC(CH₃)₂-COOH}₂] showed the lowest inhibitory power, IC₅₀ = 1.31 × 10^-4 M. In order to understand the bioactivity of functionalized hexavanadates series, we have also used a combined theoretical approach: determination of electrostatic potential from ab initio theoretical calculations and computation of the molecular interaction field (MIF) surface.

Fatal cardiac glycoside poisoning due to mistaking foxglove for comfrey

CONTEXT

Accidental ingestion of foxglove (Digitalis purpurea) can cause significant cardiac toxicity. We report a patient who ingested foxglove mistaking it for comfrey and developed refractory ventricular arrhythmias. The patient died despite treatment with digoxin-specific antibody fragments (DSFab) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO).

CASE DETAILS

A 55-year-old woman presented to the emergency department with nausea, vomiting and generalized weakness eight hours after drinking "comfrey" tea. She had bradycardia (54 beats/min) and hyperkalemia (7.6 mEq/L). Electrocardiogram revealed a first-degree atrioventricular conduction block with premature atrial contractions, followed by polymorphic ventricular tachycardia three hours after arrival. A serum digoxin level was 151.2 ng/mL. The patient developed ventricular fibrillation while waiting for Digibind infusion. Resuscitation was performed and an emergent VA-ECMO was set up. A total of eight vials of Digibind were given over the next 16 hours. She temporarily regained consciousness, but remained hemodynamically unstable and subsequently developed lower limb ischemia and multiple organ failure, and she expired on hospital day seven. A botanist confirmed that the plant was foxglove.

CONCLUSIONS

The diagnosis of cardiac glycoside plant poisoning can be difficult in the absence of an accurate exposure history. In facilities where DSFab is unavailable or insufficient, early VA-ECMO might be considered in severely cardiotoxic patients unresponsive to conventional therapy.