Digitalis Intoxication Induced by an Acute Accidental Poisoning by Lily of the Valley

An 87-year-old woman suffering from advanced dementia was admitted on May 1, 2010, for an accidental ingestion of 2 sprigs of lily of the valley offered to her by her family. She arrived 2 hours after ingestion to the emergency department with digestive disorders (nausea and an episode of vomiting). An initial clinical examination found a blood pressure of 155/85 mm Hg, a heart rate of 45 bpm, and a normal cardiovascular examination. The initial ECG showed sinus bradycardia at 45 bpm and repolarization disorders in the anterior and lateral derivations (Figure 1A). Her kalemia was 4.4 mmol/L, plasma creatinine was 66 μmol/L, and troponin was <0.06 μg/L. Her digoxin serum concentration was in the therapeutic range. The patient was hospitalized in the intensive care unit with continuous ECG and hemodynamic monitoring. Three hours later, her heart rate and blood pressure were normalized at 70 …